NHS Choices - Behind the Headlines

Can exercise offset some of the harms of regular drinking?

"Adults who booze regularly but exercise for five hours a week are no more likely to die than teetotallers," the Mail Online reports.

A study suggests exercise may compensate for some, but certainly not all, of the harms associated with excessive alcohol consumption. This latest study looked at deaths from cancer and cardiovascular disease, as well as premature death in general (usually judged to be dying before the age of 75).

Researchers looked at around 10 years' worth of national survey data from UK adults aged over 40. Unsurprisingly, they found links between all-cause and cancer mortality in inactive people. But they also found increasing levels of physical activity generally removed the association with drinking habits. In fact, occasional drinking was associated with a significant reduction in all-cause mortality for the most active of people.

Although the study had strengths in its large sample size and regular follow-up, we can't be sure that any links observed were solely down to the interaction between alcohol and exercise. For example, people who are physically active may also avoid smoking and consume healthy diets. It is difficult to completely control for such influences when analysing data like this.

While regular exercise may mitigate against some of the harms associated with excessive alcohol consumption it certainly won't make you immune. Many world-class sportspeople, such as George Best and Paul Gascoigne, have had both their careers and lives blighted by drinking.

 

Where did the story come from?

The UK-based study was carried out by an international collaboration of researchers from Canada, Australia, Norway and the UK. The health surveys on which the study was based were commissioned by the Department of Health, UK. Individual study authors also reported receiving funding from the National Health and Medical Research Council and University of Sydney. 

The study was published in the peer-reviewed British Journal of Sports Medicine. 

The media coverage around this topic was generally overly optimistic, highlighting that by exercising, individuals can completely undo the harm caused by excessive alcohol consumption, which is untrue.

In particular, the Mail Online claimed "Adults who booze regularly but exercise for five hours a week are no more likely to die than teetotallers" which could send out the wrong message to the public.

 

What kind of research was this?

This cohort study analysed data from British population-based surveys: Health Survey for England (HSE) and the Scottish Health Survey (SHS) to investigate whether physical activity is able to moderate the risk between alcohol consumption and mortality from cancer and cardiovascular diseases.

Cohort studies like this are useful for assessing suspected links between an exposure and outcome. However, there are potentially other factors that have a role to play in such associations and therefore the study design doesn't allow for confirmation of cause and effect.

 

What did the research involve?

The researchers collected data on 36,370 men and women aged 40 or above from Health Survey for England (1994; 1998; 1999; 2003; 2004; and 2006) and the Scottish Health Survey (1998 and 2003). Among other things, the participants were asked about their current alcohol consumption and physical activity.

Alcohol intake was defined by six categories (UK units/week):

  • never drink (lifetime abstainers)
  • ex-drinkers
  • occasional drinkers (haven't drank anything in past seven days)
  • within (previous) guidelines: <14 units (women) and <21 units (men)
  • hazardous: 14-15 units (women) and 21-19 units (men)
  • harmful: >35 (women) and >49 (men)

Frequency and type of physical activity in the past four weeks was questioned and converted into metabolic equivalent task-hour (MET-hours, which are an estimate of metabolic activity) per week according to national recommendations:

  • inactive (≤7 MET-hours)
  • lower level of active (>7.5 MET-hours)
  • higher level of active (>15 MET-hours)

The surveys were linked to the NHS Central Register for mortality data and the participants were followed up until 2009 (HSE) and 2011 (SHS). There were 5,735 recorded deaths; deaths from cancer and cardiovascular disease were of most interest for this study.

The data was analysed for associations between alcohol consumption and the risk of death from all-causes, cancer and cardiovascular disease. The results were then analysed according to levels of physical activity.

Potential confounders (such as sex, body mass index and smoking status) were controlled for.

 

What were the basic results?

Overall, the study found a direct link between all levels of alcohol consumption and risk of cancer mortality. It also found that increasing levels of physical activity reduced this association with cancer mortality, and also reduced the link with death from any cause.

  • In individuals who reported inactive levels of physical activity (≤7 MET-hours), there was a direct association between alcohol consumption and all-cause mortality.
  • However, in individuals who met the highest level of physical activity recommendations a protective effect of occasional drinking on all-cause mortality was observed (hazard ratio: 0.68; 95% confidence interval (CI): 0.46 to 0.99). It should be noted that this result just skimmed the cut-off point for statistical significance.
  • In this high activity group, there was no link between all-cause mortality and alcohol consumption within guidelines, or even hazardous amounts, but the risk was still increased for those drinking harmful amounts.
  • The risk of death from cancer increased with the amount of alcohol consumed in inactive participants, ranging from a 47% increased risk for those drinking within guidelines to 87% increased risk for those with harmful drinking.
  • In people with higher activity levels (above 7.5 MET hours) there was no significant link between any amount of alcohol consumption and cancer mortality.
  • No association was found between alcohol consumption and mortality from cardiovascular disease, although a protective effect was observed in individuals who reported the lower and higher levels of physical activity (>7.5 MET-hours) and (>15 MET-hours) respectively.

 

How did the researchers interpret the results?

The researchers concluded "we found evidence of a dose–response association between alcohol intake and cancer mortality in inactive participants but not in physically active participants. [Physical activity] slightly attenuates the risk of all-cause mortality up to a hazardous level of drinking."

 

Conclusion

This study aimed to explore whether physical activity is able to moderate the risk between alcohol consumption and mortality from cancer and cardiovascular diseases. It found that increasing levels of physical activity reduced the association for death from both all-causes and cancer.

This study has strengths in its large sample size, comprehensive assessments and long duration of follow-up. The findings are interesting, but there a few points to bear in mind:

  • As the authors mention, cohort studies such as this are unable to confirm cause and effect. Though the researchers have tried to account for various potential health and lifestyle confounding variables, there is the possibility that others are still influencing the results. A notable one is dietary habits which weren't assessed. Also, for example, the former drinkers may have quit due to other health issues which may have introduced bias.
  • The study was unable to look at binge drinking levels of alcohol consumption which would have likely had important health implications.
  • Additionally, there is always the possibility with self-reported surveys that the participants either under or over-reported their drinking habits which can increase the chance of misclassification bias.
  • Though having a large sample size, fewer people reported harmful drinking levels, so links within this category may be less reliable.
  • The study has only looked at the link between alcohol and actually dying from cancer or cardiovascular disease. Links may be different if they looked at associations between alcohol and just being diagnosed with cancer or heart disease, for example.
  • The study is also only representative of adults over the age of 40.

Overall, maintaining a healthy lifestyle seems to be the best bet for reducing the risk of any chronic disease, be it through physical activity, balanced diet or reasonable alcohol consumption.

Current alcohol recommendations for both men and women are to drink no more than 14 units per week.  

Links To The Headlines

How exercise undoes the harm from drinking: Adults who booze regularly but exercise for five hours a week are no more likely to die than teetotallers. Mail Online, September 8 2016

Two hours a week of exercise could offset the dangers of alcohol. The Daily Telegraph, September 8 2016

Exercise can cut risk from alcohol-related diseases, study suggests. The Guardian, September 8 2016

Links To Science

Perreault K, Bauman A, Johnson N, et al. Does physical activity moderate the association between alcohol drinking and all-cause, cancer and cardiovascular diseases mortality? A pooled analysis of eight British population cohorts. British Journal of Sports Medicine. Published online August 31 2016

A third of adults treated for asthma 'may not have the disease'

"The great asthma myth: A third of those diagnosed don't have the condition," reports the Mail Online.

A study in Canada found about one-third of adults diagnosed with asthma in the past five years showed no signs of the condition on retesting.

Asthma has become a common condition, and can cause serious illness or death if not treated. But symptoms come and go, meaning it's not always easy to diagnose reliably.

This study found people whose asthma could not be confirmed, despite a recent diagnosis, were less likely to have had objective tests of their lung function.

About one-third were able to safely stop taking asthma medicines under medical supervision.

In the UK, guidelines recommend doctors use spirometry tests in patients with symptoms that might be asthma when the doctor is not sure. A spirometer is a device that measures how much air you can breathe out of your lungs.

New guidelines on the best tests for asthma are being developed, but doctors are currently advised to start patients on treatment right away if there is a high likelihood of asthma based on their symptoms.

If you're not sure whether you need to continue taking asthma medication, talk to your GP.

It's not advisable to cut down asthma medicine or stop it suddenly without medical supervision, as asthma attacks can be serious.

Read more about asthma

Where did the story come from?

The study was carried out by researchers from the University of Ottawa, the University of British Columbia, the University of Manitoba, the University of Toronto, Université de Montréal, the University of Calgary, McMaster University, Dalhousie University, the University of Alberta and Université Laval, all in Canada.

It was funded by the Canadian Institutes of Health Research.

The study was published in the peer-reviewed Journal of the American Medical Association (JAMA).

The Mail Online criticised doctors for diagnosing asthma "without doing the proper tests", and repeated claims made last year that inhalers were being "dished out like fashion accessories".

However, spirometry is not a definitive test for asthma. It can miss cases (a false negative result) or suggest someone has asthma when they don't (a false positive).

Doctors are therefore currently advised to use their clinical skills as well as tests. 

What kind of research was this?

This cohort study recruited adults with a recent diagnosis of asthma and tested them repeatedly for asthma.

Researchers took people with no signs of the illness off medication and followed them for a year to see what happened. They also investigated how the patients had been diagnosed.

Cohort studies can find patterns – such as a link between asthma tests at diagnosis and the result of later retesting – but cannot prove that someone who didn't have a spirometry test at diagnosis did not have asthma, for example.

What did the research involve?

Researchers contacted thousands of people from 10 Canadian cities, asking if they'd had a diagnosis of asthma in the past 10 years.

Those who had and agreed to take part in the study were given a series of tests to confirm their diagnosis.

People whose tests didn't show signs of asthma were assessed by a lung specialist. Those who still had no signs of asthma had their medication reduced over time and, if appropriate, stopped.

They were then followed up for a year to see whether their symptoms worsened, and had two asthma tests during the year.

The first asthma test was spirometry, which measures how much air people can breathe out in one second. The test is then repeated after taking a puff from an asthma inhaler to see if that improves the results.

If it does, this indicates people have reversible airflow obstruction (reversible by medication), a key sign of asthma. If people had a negative spirometry test, they went on to further tests.

The researchers used a bronchial challenge test, in which people breathe in a chemical called metacholine that causes the airways to narrow. They then had spirometry to see how much the airways are affected at different doses.

If people did not have signs of asthma on this test, they had their dose of asthma medicine halved and were then retested after three weeks.

If those tests were normal, they stopped taking medicine altogether and were tested after another three weeks.

People who had no signs of asthma on any test then saw a lung specialist to look for an alternative diagnosis, and were followed up with two further bronchial challenge tests after 6 and 12 months.

Researchers also contacted the doctors who'd diagnosed the people in the study and asked about the process they'd used, whether they'd ordered spirometry or other tests, and for the results of those tests.

The researchers analysed the results to see how many of the people in the study could have a diagnosis of asthma ruled out. They also looked for differences between people with and without confirmed asthma.

What were the basic results?

Of the 1,026 people eligible to take part in the study, 613 completed all the study assessments and had their diagnosis of asthma either confirmed or ruled out.

  • In total, 410 (67%) people had their diagnosis of asthma confirmed and 203 (33%) had asthma ruled out.
  • Only a third of people who had asthma ruled out were taking asthma medication on a daily basis, though 79.3% were taking asthma medication occasionally.
  • Half of those with a confirmed diagnosis used asthma medication daily and 90% occasionally.
  • Only 86 people had their asthma confirmed by the initial spirometry test. Some (28) weren't diagnosed by tests at all, but had their diagnosis confirmed by a specialist at the final consultation.
  • Alternative diagnoses for the 203 people who'd had asthma ruled out included rhinitis and acid reflux. But 61 people (27%) had no symptoms of breathing trouble at all. Twelve people had serious cardiovascular conditions that had been misdiagnosed.
  • People whose diagnosis was ruled out were more likely to have been diagnosed without undergoing spirometry tests than people whose diagnosis had been confirmed. Just 43.8% of people whose diagnosis was ruled out had undergone airways tests at diagnosis, compared with 55.8% of people whose diagnosis was confirmed.
How did the researchers interpret the results?

The researchers say their results show that either people were misdiagnosed, or their condition had got better between diagnosis and retesting.

They say the test results, including follow-up results, show asthma symptoms and test results do come and go.

However, the researchers say the study suggests that "misdiagnosis of asthma may occasionally occur in the community".

They say 24% of doctors didn't answer requests for information about diagnosis of their patients, so it's "impossible to determine whether the initial diagnostic workup [initial assessment by their doctor], and hence the initial diagnosis of asthma in these participants, were appropriate".

This means we don't know to what extent the results were down to diagnosis or natural fluctuations in asthma symptoms.

Conclusion

The study results show being diagnosed with asthma at one point in your life doesn't necessarily mean you need to take asthma medication forever.

This study has some limitations. It was carried out in Canada, where the health service is different and doctors may use different practices to diagnose asthma. That means we don't know if the results are applicable to the UK.

Also, many people invited to take part did not do so, which means the participants may not be representative of the general population of people with asthma.

Not all doctors provided records of diagnosis, so we don't know how many people actually had asthma tests.

A third of people without asthma were not taking daily medication anyway, which indicates that they did not have current symptoms of asthma.

UK guidelines suggest people should have their need for asthma medication checked regularly so they don't take more than they require to keep symptoms under control.

Some people may be able to decrease their doses and then stop taking medication completely with medical supervision.

But it's not something you should do without your doctor's advice, as asthma attacks can be dangerous.

While tests like spirometry can help doctors make a diagnosis, they're not foolproof.

The National Institute for Health and Care Excellence (NICE) is currently looking at its advice on the diagnosis of asthma, and is expected to make new recommendations about the use of tests. 

At present, spirometry is recommended for all people presenting with possible asthma. However, a normal result does not rule out asthma.

Further lung function tests, such as peak expiratory flow, are recommended to confirm the diagnosis and for monitoring purposes.

If you're unsure whether your asthma medication is helping or you don't know whether you need to take it anymore, talk to your GP.

They can ask you about your symptoms, offer tests, and help you decide how best to manage your condition.

Read more about living with asthma.   

Links To The Headlines

The great asthma myth: A third of those diagnosed DON'T have the condition, study finds. Mail Online, January 17 2017

One third of asthmatics may not have the condition, study suggests. The Daily Telegraph, January 17 2017

One in three people diagnosed with asthma do NOT have the condition, experts warn. Daily Mirror, January 17 2017

Third of those treated for asthma don't really have it. The Times, January 18 2017 (subscription required)

Links To Science

Aaron SD, Vandemheen KL, FitzGerald M, et al. Reevaluation of Diagnosis in Adults With Physician-Diagnosed Asthma. JAMA. Published online January 17 2017

Eating disorders in middle-aged women 'common'

"Eating disorders…affect a small but substantial number of women in their 40s and 50s," BBC News reports. While often regarded as a "disease of the young", a new survey suggests 3.6% of middle-aged women in the UK are affected by an eating disorder.

Researchers also looked at childhood, parenting and personality risk factors associated with the condition. They found that 15% of middle-aged women had experienced an eating disorder at some point in their lifetime, and 3.6% had one in the last 12 months.

A commonly reported disorder is what is known as "other specified feeding and eating disorder". This term describes cases where a person may not fit the precise pattern of eating disorders such as anorexia but they still experience significant distress due to an unhealthy psychological relationship with food.

The study found that all potentially harmful childhood life events such as child sexual abuse, death of a carer and parental divorce, were associated with the onset of eating disorders. However, the study can't prove that these factors caused the disorder.

The researchers hope this survey will highlight that when it comes to diagnosing eating disorders, health service provision for middle aged women could be improved.

Read more about the help available for people with eating disorders as well as advice for friends and family who may be worried about others.

 

Where did the story come from?

The study was carried out by researchers from several UK, US and Swedish institutions including University College London, Harvard Medical School and the Karolinska Institutet in Stockholm. It was funded by the National Institute of Health Research UK and the UK children's charity Wellchild.

The study was published in the peer-reviewed medical journal BMC Medicine on an open-access basis, so it is free to read online.

BBC News provided a well-balanced report on the study.

In contrast, the Daily Mail's reporting was both confused and confusing. Its headline: "Divorce blamed as more middle-aged women are hit by eating disorders", would naturally lead readers to assume it is going through divorce is a risk factor. But the study only explicitly mentions parental divorce as a risk factor in childhood.

 

What kind of research was this?

This was a cross-sectional analysis which used data from an existing longitudinal study – the UK Avon Longitudinal Study of Parents and Children (ALSPAC) to investigate the prevalence of eating disorders in middle-aged women. Within this, the researchers explored childhood, parenting and personality risk factors associated with the condition.

Eating disorders are severe mental health problems which cause an individual to change their eating habits and behaviour. The conditions can affect someone physically, psychologically and socially.

Traditionally, these conditions are associated with younger women but the researchers recently identified a gap in access to healthcare for adults with eating disorders in a UK population. As a result, they wanted to investigate this further.

Observational studies like this one are useful for assessing the incidence and prevalence of health conditions. However the study design limits the ability to prove causation between exposure and outcome, for example, between a potential risk factor and the development of an eating disorder. 
 

What did the research involve?

The data for this analysis was obtained from ALSPAC, a population-based prospective cohort study of women and their children.  ALSPAC followed 14,541 pregnant women and examined the effects of environment, genetic and other factors on them and their children.

This analysis included a sample of 9,233 of the women (average age 48 years) and asked them to complete a version of the Eating Disorders Diagnostic Schedule (EDDS). The EDDS uses different criteria to diagnose the following conditions:

Women who were screened positive (5,655) based on the screening criteria were interviewed using the eating disorders section of the Structured Clinical Interview for DSM-IV-TR disorders (SCID-1).

The interview assessed presence, frequency and duration of behaviours associated with eating disorders such as restriction, fasting, excessive exercise, binge eating, and purging. The women were asked to relate any changes in their eating behaviours with major life events to see if they were potentially associated.

Data for 1,043 women on relevant predictors of the onset of eating disorders was obtained from the ALSPAC database collected 20 years prior to this analysis:

  • childhood unhappiness
  • parental divorce or separation, adoption or being under health authority care
  • death of a carer
  • early sexual abuse
  • life events
  • bonding with parents
  • locus of control (LOC ) – whether a person feels in control of their life
  • interpersonal sensitivity

The data was then analysed to search for any potential associations between risk factors and the onset of eating disorders.

Potential confounders such as maternal age, ethnicity and education were adjusted for.

 

What were the basic results?

Overall the researchers found 15% of middle aged women had experienced an eating disorder in their lifetime, and 3.6% had one in the last 12 months.

Anorexia nervosa was the most common specific lifetime disorder, with a prevalence of 3.6%, though the general category of "other specified feeding and eating disorder" was most common, affecting 7.6%.

Several links emerged between early risk factors and the onset of eating disorders:

  • Experiencing the death of a carer was associated with a seven-fold increase in odds for the onset of purging disorder (odds ratio [OR] 7.12; 95% confidence interval [CI] 2.32 to 21.85).
  • There were higher odds of suffering from bulimia nervosa (OR 2.02), binge eating disorder (OR 2.01) and anorexia nervosa (OR 2.49) following parental separation or divorce in childhood.
  • Child sexual abuse was associated with all disorders linked to binge eating behaviours: anorexia nervosa binge purge (OR 3.81), bulimia nervosa (OR 4.70) and binge eating disorder (OR 3.42).
    Sexual abuse from a non-stranger was linked with anorexia nervosa binge purge, bulimia nervosa and binge eating disorder.
  • Childhood unhappiness was associated with increased odds of anorexia nervosa (OR 2.52), bulimia nervosa (OR 4.58), binge eating disorder (OR 3.66) and purging disorder (OR 2.65).

Overall, all the childhood life events were positively associated with eating disorders, and the more life events there were, the higher the risk.

 

How did the researchers interpret the results?

The researchers concluded: "Although some risk factors differed across [eating disorder] subtypes, childhood sexual abuse and poor parenting were associated with binge/purge type disorders, whilst personality factors were more broadly associated with several diagnostic categories. Few risk factors were specifically associated with one diagnostic category."

 

Conclusion

This well-designed cross-sectional analysis used data from an existing longitudinal study to investigate the prevalence of eating disorders in middle-aged women and see what childhood, parenting and personality risk factors were associated with the onset of an eating disorder.

The research found that more than 1 in 10 middle aged women experience some form of eating disorder in their lifetime. It found that all potentially harmful childhood life events such as child sexual abuse, death of a carer and parental divorce, were associated with the onset of eating disorders.

An association with traumatic life events is definitely plausible, or even likely. However, it must be noted that within the context of observational survey data, such studies are never able to prove that any single exposure causes the development of an eating disorder.

This study has not been able to take into account all aspects of a person's mental and physical health, interpersonal relationships and lifestyle prior to the onset of an eating disorder. Therefore the study can show associations but cannot prove definite causation with any individual factor.

The researchers say that this research has implications for health service provision in the UK, which needs to recognise that women in mid-life can still be suffering from the effects of long-standing disorders, or be at risk of developing new disorders. Therefore better awareness of eating disorders and their symptoms is needed.

Dr. Agnes Ayton, Vice Chair of the Faculty of Eating Disorders, Royal College of Psychiatrists commented on the research saying:

"This is an important paper, which has several methodological strengths: it is population-based (rather than only including people who seek contact with health care, which is always the tip of the iceberg). It has used reliable assessment of the eating disorder, by interviewing with validated instruments, rather than relying on self-report. It was also able to identify risk factors, which were collected many years ago as part of the AVON Longitudinal Study, therefore avoiding recall bias.

"It demonstrates that the rates of eating disorders amongst middle age women are higher than it was thought, and that significant proportions of these people are unknown to services – so there is a large unmet need."

Find eating disorders support services in your local area.

Links To The Headlines

Eating disorders can strike in mid-life. BBC News, January 17 2017

Divorce blamed as more middle-aged women are hit by eating disorders: 15% have battled bulimia or anorexia. Daily Mail, January 17 2017

Rising number of middle-aged women are ‘battling anorexia and bulimia’, new figures warn. The Sun, January 17 2017

Eating disorders are hitting more women in middle age. Daily Mirror, January 17 2017

Study uncovers hidden epidemic of eating disorders in middle-aged women. The Daily Telegraph, January 17 2017

Links To Science

Micali N, Martini MG, Thomas JJ, et al. Lifetime and 12-month prevalence of eating disorders amongst women in mid-life: a population-based study of diagnoses and risk factors. BMC Medicines. Published online January 17 2017

Can colic really be cured by acupuncture?

"Is sticking needles in babies really the best way to ease distress from colic?" the Daily Mail asks.

The question was prompted by a study that looked at whether acupuncture can help with colic in babies.

Colic is a common yet poorly understood condition that causes excessive and prolonged crying in babies. It's not serious, but can be distressing for parents.

Researchers randomly assigned 157 babies aged two to eight weeks to three treatment groups: standard care, minimal acupuncture, and acupuncture based on the principles of traditional Chinese medicine.

They found the total time spent crying was reduced by around 40 minutes a day in babies allocated to the acupuncture groups.

While this is a well-designed trial, the findings should be interpreted with some caution.

The researchers set out to compare two different forms of acupuncture, but had to combine the groups as they did not analyse enough infants to reliably detect differences.

Also, as acupuncture caused crying in more than three-quarters of the babies treated, it's questionable how useful it is as an intervention to stop excessive crying. 

A larger trial would be required to confirm whether acupuncture is an effective and acceptable treatment for colic.

More traditional ways to treat colic include holding your baby during a crying episode, sitting or holding them upright during feeding to prevent them swallowing air, and avoiding too much tea, coffee and other caffeinated drinks if you're breastfeeding.

Where did the story come from?

The study was carried out by researchers from Lund University in Sweden and was funded by Ekhagastiftelsen, Family Uddenäs.

It was published in the peer-reviewed journal Acupuncture Medicine on an open access basis, so it's free to read online.

This has been covered widely by the UK media.

While the actual reporting of the study has been broadly accurate, as is so often the case some headline writers have overstated the implications of the results.

A case in point is The Daily Telegraph's headline: "Acupuncture helps young babies stop crying".

The Daily Mail's headline – "Scientists split over using acupuncture to treat the condition" – is much more accurate, as it reflects the difference of opinion among independent experts.

Professor George Lewith of the University of Southampton is quoted as saying: "This looks to me to be a good-sized, fastidious, well-conducted study … which suggests that minimal acupuncture is a reasonable and, as far as we know, safe intervention for infantile colic."

A contrasting view is provided by Professor David Colquhoun, who is quoted as saying: "What parent would think that sticking needles into their baby would stop it crying? The idea sounds bizarre. It is." 

What kind of research was this?

This randomised controlled trial aimed to assess two acupuncture protocols against usual care for the treatment of colic in infants. 

This type of trial is the best way of assessing a specific intervention, as the random assignment of participants to groups reduces the risk of bias and means any differences seen are likely to be the result of the intervention.

And as all the babies were presumably unaware on a conscious level of the treatment they were receiving, there was a level of blinding normally lacking in acupuncture research.

What did the research involve?

The study was carried out at four child health centres in Sweden.

Parents seeking help for their baby's colic were informed of the trial and invited to participate if they met eligibility criteria.

The researchers randomly assigned infants to one of three treatments groups.

In addition to usual child healthcare, the infants received:

  • standardised minimal acupuncture – based on a Western understanding of the nervous system
  • semi-standardised individual acupuncture – inspired by traditional Chinese medicine, which is based on "acupuncture points"
  • no acupuncture

To be eligible for the trial, infants had to meet the following requirements:

  • fulfil criteria for colic – crying for at least three hours a day at least three days a week
  • aged two to eight weeks
  • have healthy and appropriate weight gain
  • have tried a diet excluding cow's milk protein from breastfeeding mothers or appropriate formula for at least five days

Infants were excluded if they were born preterm (earlier than 37 weeks), taking any medication, or had previously tried acupuncture.

Parents recorded their infants' fussing and crying in a daily diary at the start of the trial (baseline) and at the end of the first and second week.

At the first visit, the nurse collected informed consent and background data.

At each of the following visits, parents were asked questions about changes in crying, bowel habits and sleep patterns, and any side effects they associated with acupuncture.

Three days after completing the second week, a follow-up phone interview was carried out.

The main outcome of interest was the difference in total crying time – this is the sum of the time spent fussing, crying and colicky crying between baseline and the end of the second week.

The researchers were also interested in the number of infants in each group who continued to fulfil the criteria for colic.

The intervention was delivered by trained acupuncturists. The nurses providing assessments at the child health centres and the parents were blinded to the treatment group.

What were the basic results?

Of 157 infants randomised, a total of 147 started the intervention, and 144 completed the trial.

As the trial ended early, it was not possible for the researchers to include an adequate number of infants in each of the acupuncture groups to provide solid findings.

The acupuncture groups were therefore combined to compare the overall effects of acupuncture with no acupuncture.

While receiving either type of acupuncture, the infants:

  • did not cry on 200 occasions
  • cried for up to one minute on 157 occasions
  • cried for more than one minute on 31 occasions 

When compared with usual care alone, the total crying time at the end of week one and two was significantly lower for infants receiving acupuncture (170 versus 206 minutes a day in week one, and 137 versus 176 in week two).

However, this was no longer statistically significant at later follow-up (123 versus 164 minutes a day). 

Looking at the three individual outcomes, the overall amount of time spent crying decreased significantly more in the acupuncture groups compared with usual care (40% reduction versus 22% reduction) between baseline and the end of the second week.

However, no significant difference was seen for fussing or colicky crying by the second week.

During the follow-up period, only colicky crying showed a significant difference in favour of acupuncture (92% reduction versus 65% reduction).

More infants receiving acupuncture cried less than three hours per day – and therefore no longer fulfilled criteria for colic – in the first and second week.

Looking at adverse effects, the acupuncturists reported the babies cried during more than three-quarters of the treatment sessions.

There were reports of blood in 15 out of 200 treatments. Otherwise, no adverse effects were reported. 

How did the researchers interpret the results?

The researchers concluded that, "Among those initially experiencing excessive infant crying, the majority of parents reported normal values once the infant's crying had been evaluated in a diary and a diet free of cow's milk had been introduced.

"Therefore, objective measurement of crying and exclusion of cow's milk protein are recommended as first steps to avoid unnecessary treatment.

"For those infants that continue to cry more than three hours a day, acupuncture may be an effective treatment option. The two styles of [acupuncture] tested in [the trial] had similar effects; both reduced crying in infants with colic and had no serious side effects.

"However, there is a need for further research to find the optimal needling locations, stimulation and treatment intervals." 

Conclusion

This randomised controlled trial aimed to compare two types of acupuncture treatment with usual care in infants with colic.

This trial has a number of strengths and limitations. It was well designed, and the researchers increased its validity by using a robust study protocol. Assessors were also blinded to treatment group.

However, the researchers did not analyse enough infants to be able to reliably detect a meaningful difference between the two different types of acupuncture, and therefore had to pool the groups.

As such, the study only looks at acupuncture in general and cannot provide information on a particular form of delivery.  

It's also possible that parents who were willing to try acupuncture were not representative of all parents of children with colic.

These cases may be more severe, causing parents to try more controversial treatments.

The follow-up period was short at two weeks, and we do not know if any effects seen would be sustained without continuous treatment.

There was also an imbalance at baseline in the number of infants who were breastfed – as this is a risk factor for colic, this may have increased the risk of bias.

The researchers reported no serious side effects. But considering that this is a treatment for excessive crying, you could question the merit of a procedure that causes further crying.

As this trial was not able to look at the effects of the two different forms of acupuncture on colic, a larger trial is required to confirm whether acupuncture could be an effective and acceptable form of treatment for colic, and how it could be delivered.

If your baby has colic, there are lots of ways you can try to comfort them: you can try holding your baby during a crying episode, sitting or holding them upright during feeding to prevent them swallowing air, and avoiding drinking too much tea, coffee and other caffeinated drinks if you're breastfeeding.

Read more about treating colic and soothing a crying baby.

Links To The Headlines

Is sticking needles in babies really the best way to ease distress from colic? Scientists split over using acupuncture to treat the condition. Daily Mail, January 17 2017

Acupuncture helps young babies stop crying – new research. The Daily Telegraph, January 16 2017

Two weeks of acupuncture could 'STOP your baby crying, curing colic'. The Sun, January 16 2017

Links To Science

Landgren K, Hallström I. Effect of minimal acupuncture for infantile colic: a multicentre, three-armed, single-blind, randomised controlled trial (ACU-COL). Acupuncture in Medicine. Published online January 16 2017

Hot red chilli peppers linked to longer lifespan

"How hot chilli could help you live longer," the Daily Mail reports. A US study found that people who reported eating red hot chilli peppers had around a 13% reduced risk of premature death compared to those who avoided them.

The study looked at adults in the 1980s and 90s who reported eating any hot chillies over the past month – which could range from a single chilli to several chillies every day.

There were no significant links found when drilling down to specific cause of death rather than just overall mortality.

Ultimately this study proves very little. The researchers attempted to account for possible contributory factors, such as other dietary factors, income and age, but as they admit, unmeasured health and lifestyle factors could be influencing the link.

It is plausible that hot chillies could be linked beneficial effects. There is some evidence that the active ingredient in red hot chilli peppers, (the food, not the band) capsicum may have anti-inflammatory or anti-oxidant effects, while also boosting the metabolism. But with the exception of one study in China (which we analysed in 2015) the research has involved rodents.

It is always unwise to rely on a single "superfood", such as assuming that chillies could be the spice of a long life. It is better to follow standard recommendations and eat a balanced diet high in a variety of fruit and vegetables, limit salt, sugar and saturated fat – stay activeavoid smoking and moderate your consumption of alcohol.

 

Where did the story come from?

The study was carried out by two researchers from University of Vermont College of Medicine in the US. The authors report receiving no funding for their study and declare no conflict of interest. The study is published in the peer-reviewed journal PLOS ONE, an online open-access journal so the study is free to read online.

The Mail's coverage rather takes these findings at face value. This study does not prove that eating hot chillies will help you live longer.

 

What kind of research was this?

This was a cohort study which aimed to see whether consumption of hot chilli peppers was linked with mortality.

The researchers say that evidence on the health effects of spice consumption is lacking, particularly from Western populations. Therefore they aimed to investigate this using a large cohort of US citizens. The difficulty is that observational studies can never prove cause and effect between single dietary factors and health outcomes. Many other factors may be confounding any link. Self-assessments of frequency and quantity of consumption of individual food items can also commonly be subject to recall bias.

 

What did the researchers do?

The research used data from the National Health and Nutritional Examination Survey version III (NHANES III). Data was collected between 1988 and 1994 and the participants were at least 18 years old and said to be representative of the US adult population.

Survey participants took part in interviews assessing their health, lifestyle and socioeconomic factors. As part of this they completed an 81-item food frequency questionnaire assessing usual consumption of food and drink items over the past month.

Hot red chilli pepper consumption per month was assessed from responses to the question "How often did you have hot red chili peppers? Do not count ground red chili peppers." The researchers considered any response other than no chillies per month as a chilli consumer.

The researchers followed up mortality (by cause) by linking with the National Death Index to end of 2011. In their analyses between mortality and chilli pepper consumption the researchers adjusted for these confounders:

  • age, gender and ethnicity
  • marital status
  • educational level, employment and annual income
  • physical activity
  • consumption of meats, vegetables and fruits

 

What did they find?

A total of 16,179 adults had complete data for analysis.

Various factors were linked with increased chilli consumption, for example being younger, male, white, Mexican-American, being a smoker and drinking alcohol, and consuming more meat and other vegetables.

During an average follow-up of 18.9 years there were 4,946 deaths – 21.6% of the chilli consumers died compared with 33.6% of the non-consumers.

In the model adjusted for all confounding variables, any level of chilli consumption was linked with a 13% reduced risk of dying during follow-up (hazard ratio [HR] 0.87, 95% confidence interval [CI] 0.77 to 0.97).

When looking by specific cause of death, however, no significant links were found between chilli consumption and any cause of death.

 

What did the researchers conclude?

The researchers conclude: "In this large population based prospective study, the consumption of hot red chili pepper was associated with reduced mortality. Hot red chili peppers may be a beneficial component of the diet."

 

Conclusions

The researchers conclude from their observational study that hot chillies may be beneficial to health.

However, there are several points to bear in mind:

  • This is observational survey data that can't prove direct cause and effect. The researchers have made a valiant attempt in following the survey participants for mortality outcomes for almost 20 years, and tried to adjust for many different health and lifestyle factors that could be influencing the link. However, it is still likely that these adjustments have not been able to fully account for all of these factors – and there may be other unmeasured factors that are influencing the link.
  • The analysis only looks at the very general link with any hot chilli consumption in the past month vs. none. It doesn't look at quantity or frequency of chilli consumption – or type of chilli for that matter. Therefore the "chilli consumers" could include anything from a person who included a single chilli in a curry over the past month, for example, to people who daily eat several of the hottest chillies. Therefore it doesn't give you a great deal to go on.
  • No links were found with any particular cause of death – only the overall association with mortality that has compiled all deaths. This makes it more difficult to draw much meaning from the results. Even if chillies are directly influencing mortality, this study can't tell us by what mechanism they could be doing this.
  • The study has only looked at a specific US population sample – and their chilli consumption was assessed over 20 years ago. They may not be representative of people today, of the US culture or others.

It is plausible that hot chillies could be linked with health effects – possibly similar to how flavonoids or pigments of other fruit and vegetables have been linked with anti-inflammatory or anti-oxidant effects – or it could be down to capsicum, the active ingredient in chillies. But this is just speculation – there's no good evidence around this.

Ultimately, rather than looking for a single "superfood" that will boost health and reduce mortality risk, you're probably better off just following the standard recommendations. Eat a balanced diet high in a variety of fruit and vegetables, limit salt, sugar and saturated fat – stay activeavoid smoking and moderate your consumption of alcohol.

Links To The Headlines

How hot chilli could help you live longer: Regularly eating the peppers found to reduce the chance of dying by 13%. Daily Mail, January 16 2017

Links To Science

Chopan M, Littenberg B. The Association of Hot Red Chili Pepper Consumption and Mortality: A Large Population-Based Cohort Study. PLOS ONE. Published online January 9 2017

Urine test could reveal if your diet is a threat to your health

"A urine test that can reveal how healthy your meals are has been developed by UK scientists," BBC News reports.

Researchers wanted to see if they could help crack one of the biggest problems confronting people trying to carry out studies into diet and health. Namely, that the most widely used method to assess diet – self-reporting – is notoriously unreliable.

Study after study has found that most people are prone to under-reporting the amount of unhealthy food they eat while over-reporting the amount of healthy food.

In this small study, on four separate occasions, 20 participants consumed four different diets which were assessed as ranging from very healthy (in terms of agreeing with international guidelines) to unhealthy.

Urine samples were tested for substances known to be associated with certain types of dietary patterns (metabolic profiles).

The researchers found that urine tests were in fact robust enough to identify dietary patterns in the participants – the levels of 19 substances (metabolites) were significantly higher in the healthiest of the four diets compared with the unhealthiest.

As this study had a very small sample size, it's likely that more research will be needed to verify the findings, before considering how best urine tests could be adopted as a dietary tool for health services.

If you are looking to make your diet more healthy, you may want to start keeping a food diary – where you record exactly what you eat, rather than relying on your unreliable memory.

 

Where did the story come from?

The study was carried out by researchers from a range of institutions in the UK, US and Denmark including Imperial College London, Northwestern University and the University of Southern Denmark.

It was funded by the UK National Institute for Health Research and the UK Medical Research Council. Some of the researchers have received payments the large food and consumer goods manufactures Unilever and Nestlé.

The study was published in the peer-reviewed scientific journal Lancet Diabetes and Endocrinology. It is available on an open-access basis so is free to read online.

Both BBC News and the Mail Online's reporting of the study was accurate.

 

What kind of research was this?

This was a randomised-controlled crossover trial which wanted to investigate whether dietary intake in individuals could be revealed and measured using urine samples.

Diet has a part to play in the increase in risk of non-communicable (non-infectious) diseases such as type 2 diabetes and heart disease. Current dietary tools aren't always able to assess the effect of policy change on dietary behaviour in populations. The researchers wanted to see if urine metabolic profiles could reflect dietary intake and offered an alternative method to do this.

Randomised trials are one of the best ways to determine the effects of an intervention. Crossover trials are when participants act as their own control and receive the different tested interventions in random order, in this case the different diets. They are often used when the sample size is small – as was the case with this trial – as a way to boost the numbers for comparison.

In this study, it wasn't possible to blind the participants from the dietary intervention but the individuals analysing the data were prevented from knowing the randomisation order.

 

What did the research involve?

Between August 2013 and May 2014, healthy volunteers (aged 21-65) with a body mass index (BMI) between 20–35kg/m2 were recruited for this study from a database at the UK National Institute for Health Research (NIHR)/ Wellcome Trust Imperial Clinical Research Facility (CRF).

Of a potential 300 recruited by invitation letter, only 26 were eligible and attended a health screening, 20 of these people were randomised in the trial.

The trial aimed to assess four dietary patterns which varied in a stepwise manner in their compliance with World Health Organization (WHO) healthy eating guidelines. Essentially the diets gradually increased in content of fruits, vegetables, whole grains, and dietary fibre, while decreasing in their content of fats, sugars, and salt.

Participants were asked to attend four inpatient stays of 72 hours (separated by at least five days) during which they were given one of the four dietary interventions. The order of the diets was randomised across each study visit.

Adherence to the interventions was closely monitored with food weighed immediately before and after being given to the participants. Additionally, participants were only allowed to engage in very light physical activity – this was also closely monitored.

During the inpatient stay, urine was collected three times every day: morning collection (0900-1300h), afternoon collection (1300-1800h), and an evening and overnight collection (1800-0900h).

Of the 20 participants, 19 completed the full trial and their urine samples were assessed for metabolic profiles using proton nuclear magnetic resonance (1H-NMR) spectroscopy. This is a process to analyse the chemical compositions of a substance.

 

What were the basic results?

Overall, the urine metabolic profiles were distinct enough to assess each of the diets consumed. The metabolite concentrations translated to specific components of each diet.

The results were interesting, for example, the 1H-NMR analysis showed that the presence of 19 metabolites were in significantly higher concentrations after consumption of diet 1 – which had the greatest agreement with WHO dietary recommendations – compared to diet 4 – the highest risk diet with the least agreement to recommendations.

The analysis also showed detailed variability in metabolite concentrations between the participants.

 

How did the researchers interpret the results?

The researchers concluded: "Urinary metabolite models developed in a highly controlled environment can classify groups of free living people into consumers of diets associated with lower or higher non-communicable disease risk on the basis of multivariate metabolite patterns.

"This approach enables objective monitoring of dietary patterns in population settings and enhances the validity of dietary reporting."

 

Conclusion

This well-designed, randomised crossover trial investigated whether the dietary intake in individuals could be revealed and measured using urine samples and found that it is possible.

Urine analysis using 1H-NMR spectroscopy was distinct enough to distinguish "healthier" and higher risk diets by looking at the metabolites present in the urine.

The researchers hope that this study offers a method which could be used to assess adherence to healthy eating programmes, and potentially be used as a screening tool to identify and monitor individuals at risk of obesity and non-communicable diseases.

These tests have the potential to be of benefit as a research tool. Some studies have suggested that as many as 88% of people record their dietary intake inaccurately, so an independent objective measuring tool, could be very helpful.

Although this study sounds promising, the study sample was small with only 19 participants completing the full trial. Even in the context of a crossover trial this is very small and may not give reliable enough results from which to draw firm conclusions.

Further research with a much larger sample size may be required to see that urine metabolite testing is accurate enough to distinguish dietary patterns and then be used by researchers and health services.

If you are trying to improve your diet, and possibly lose weight, then following the NHS Choices Weight Loss Plan may help. This provides downloadable "diet diary" sheets as well as suggestions for healthy meal choices.

Links To The Headlines

Urine test reveals what you really eat. BBC News, January 13 2017

Five-minute test that says if your diet's healthy by analysing biological markers created by the breakdown of meat, fruit and vegetables. Mail Online, January 13 2017

Links To Science

Garcia-Perez I, Posma JM, Gibson R, et al. Objective assessment of dietary patterns by use of metabolic phenotyping: a randomised, controlled, crossover trial. The Lancet – Diabetes and Endocrinology. Published online January 12 2017

Yoga 'may improve lower back pain'

"Yoga can help relieve the agony of back pain, a major review of medical evidence found," the Daily Mail reports.

The review concluded there is evidence yoga may help improve function and relieve pain associated with chronic lower back pain in some people. 

The review looked at 12 studies that compared the effects of yoga with other treatments, such as physiotherapy, as well as no treatment. 

Researchers found yoga had some benefit for people with lower back pain compared with people who did no exercise for their back.

The results were less convincing for those who were already engaged in some other form of exercise.

Yoga includes the integration of physical poses and controlled breathing, sometimes also with meditation.

The results also demonstrated that a minority of participants had worse back pain after following a yoga regime, but the authors suggest this may be the same for any exercise.

The researchers cautioned that all of the results could have been affected by bias as it was impossible to blind the effects of yoga from the participants. This means a possible placebo effect could have been at play.

There are currently a number of recommended treatments for long-term back pain, including painkillers, exercise classes, physiotherapy or cognitive behavioural therapy (CBT). Talk to your GP about the best option for you.

What is important is to keep active as much as possible. It's now recognised that people who remain active are likely to recover from their pain more quickly.

Where did the story come from?

The study was carried out by researchers from the University of Maryland School of Medicine in the US, the University Hospital of Cologne in Germany, the University of Portsmouth in the UK, and Yoga Sangeeta in the US.

It was supported by the National Institutes of Health National Center for Complementary and Integrative Medicine in the US. The authors declared no conflict of interest.

The study was published in the peer-reviewed online journal, The Cochrane Database of Systematic Reviews. It is open access, so it's free to read the study online.

The UK reporting of the review was much more enthusiastic than the Cochrane researchers, who are known to err on the side of caution.

The Daily Telegraph excitedly reported that, "people who could most benefit from adopting the lotus position while locating their spiritual core are in fact those immobilised by pain".

But the reviewers actually concluded that, "There is low- to moderate-certainty evidence that yoga compared to non-exercise controls results in small to moderate improvements in back-related function at three and six months. Yoga may also be slightly more effective for pain at three and six months." 

What kind of research was this?

This systematic review assessed the evidence of the effects of yoga for treating chronic non-specific lower back pain, compared with no specific treatment, minimal intervention (such as education) or another active treatment.

The outcomes focused on pain, back function, quality of life and adverse events. The studies included were all randomised controlled trials (RCTs)

RCTs are one of the best ways of looking at the effect of an intervention – in this case, the effect of yoga for treating chronic non-specific lower back pain.

However, while a systematic review is useful in bringing together the evidence on a specific topic, it can only ever be as good as the studies included. Any shortfalls of the studies included will be brought forward into the systematic review.

What did the research involve?

Researchers carried out a systematic review of RCTs including adults (aged 18 or older) with current chronic non-specific lower back pain for three months or more.

Twelve studies were included, involving a total of 1,080 participants from the US, India and the UK, mostly aged between 43 and 48 years old.

Researchers included studies with yoga as an intervention for lower back pain. Yoga classes included exercises specifically for lower back pain and were carried out by experienced practitioners.

The researchers compared:

  • yoga versus no treatment, or a waiting list, minimal intervention (such as booklets, lectures or other educational interventions) or usual care (i.e. no exercise)
  • yoga versus another active intervention (such as drugs or manipulation) – different types of active interventions were considered separately
  • yoga plus any intervention versus that intervention alone – different types of intervention were considered, such as yoga plus exercise versus exercise alone

Outcome measures were looked at in the short term (around four weeks), short to intermediate term (around three months), intermediate term (around six months) and long term (around one year).

Outcomes analysed included back-specific functional status (measured by a questionnaire), pain (measured by self-assessment on a scale), and measures of quality of life, clinical improvement, work disability and adverse events.

What were the basic results?

For yoga compared with no-exercise, there was:

  • low-certainty evidence that yoga produced small to moderate improvements in back-related function at three to four months – standardised mean difference (SMD) – as assessed by the functional status questionnaire (0.40, 95% confidence interval [CI] 0.66 to  0.14)
  • moderate-certainty evidence that yoga produced small to moderate improvements in back-related function at six months (SMD 0.44, 95% CI 0.66 to  0.22)
  • moderate-certainty evidence that the risk of adverse events, mostly back pain, was higher in yoga than in non-exercise controls (risk difference [RD] 5%, 95% CI 2% to 8%)

There were no clinically significant differences in pain at three to four months, six months or 12 months for yoga compared with no exercise.

For yoga compared with non-yoga exercise controls, there was:

  • little or no difference in back-related function at three months and six months, and no information for back function after six months
  • very low-certainty evidence for reduced pain at seven months on a scale of 0-100 (mean difference [MD] 20.40, 95% CI 25.48 to 15.32)
  • no difference in adverse events between yoga and non-yoga exercise controls

For yoga added to exercise compared with exercise alone, there was little or no difference in back-related function or pain, and no information on adverse events.

How did the researchers interpret the results?

The authors concluded that, "There is low- to moderate-certainty evidence that yoga compared to non-exercise controls results in small to moderate improvements in back-related function at three and six months."

They added: "It is uncertain whether there is any difference between yoga and other exercise for back-related function or pain, or whether yoga added to exercise is more effective than exercise alone.

"Yoga is associated with more adverse events than non-exercise controls, but may have the same risk of adverse events as other back-focused exercise. Yoga is not associated with serious adverse events." 

Conclusion

There was some evidence people doing yoga – compared with those doing no exercise – saw some improvement in back-related function at three and six months.

It was not clear if those undertaking yoga, compared with other exercise or adding yoga to exercise, was any better than exercise alone.

The study does, however, have some downfalls:

  • Only 12 trials were included, the majority of which were in the US. This may mean results are less generalisable to other countries.
  • Not all trials looked at all reported outcomes. For example, only four trials were included when comparing yoga with non-yoga exercise, increasing the risk of bias.
  • All outcomes were self-reported, therefore all of the studies included were at risk of bias as participants may have wanted to demonstrate a difference to please researchers without there actually being any difference.
  • Some participants who agreed to participate in the studies would have consented to being randomised but with a preference for the yoga treatment. This may have affected their willingness to comply if they were then not allocated to their preferred group.
  • All faults with the original studies – for example, people dropping out halfway through treatment – were carried forward into the systematic review, and it is therefore difficult to say how much this would have affected the findings.

When it comes to lower back pain, it is important to stay as mobile as possible – yoga could be one of a range of possibly beneficial exercise-based treatments for back pain.

Read more about taking care of back pain.

Links To The Headlines

If you want to do ease back pain, do some yoga: Practice is twice as good as other exercises at helping discomfort. Daily Mail, January 12 2017

Yoga is the key to relieving long-term back pain, new study suggests. The Daily Telegraph, January 12 2017

Links To Science

Wieland LS, Skoetz N, Pilkington K, et al. Yoga treatment for chronic non-specific low back pain. Cochrane Database of Systematic Reviews. Published online January 12 2017

A pattern of brain activity may link stress to heart attacks

"The effect of constant stress on a deep-lying region of the brain explains the increased risk of heart attack, a study in The Lancet suggests," BBC News reports.

Research suggests that stress stimulates the amygdala. The amygdala is, in evolutionary terms, one of the oldest areas of the brain and has been linked to some of the most primal types of emotion, such as fear and stress. It is thought to be responsible for triggering the classic "fight or flight" response in situations of potential danger.

Researchers in the US, using medical imaging, found that higher levels of activity in the amygdala predicted how likely people were to have a heart attack or stroke.

People with an over-active amygdala were also likely to show more activity in their bone marrow, which makes blood cells, and to have inflamed blood vessels. The researchers think their findings are linked – that stress activates the amygdala, which prompts the bone marrow to produce more cells, causing inflammation of the arteries, which in turn, raises risk of heart attacks and strokes.

While the theory is plausible, the study was quite small and due to its design, can't prove cause and effect.

A final interesting point, raised in the study, is evidence that mindfulness-based meditation has been shown to reduce amygdala activity. It may be possible that meditation could reduce the risk of stress-based heart attack or stroke.

Read more about how mindfulness can improve wellbeing.

 

Where did the story come from?

The study was carried out by researchers from Massachusetts General Hospital, Weil Cornell Medical College, Icahn School of Medicine and Tufts University, all in the US. The researchers say the study had no specific funding, although they acknowledge grants from the US National Institutes of Health.

The study was published in the peer-reviewed medical journal The Lancet.

The Sun and the Daily Mirror headlines both suggested this was the first time stress had been linked to cardiovascular disease (specifically heart attacks and stroke), but the link has actually been known for over a decade.

Other media outlets correctly identified that the possible mechanism behind the link is the real newsworthy issue.

However, most reports presented the mechanism as if it was fact, rather than a theory that still needs further research.

 

What kind of research was this?

The researchers did two types of study.

The first was a longitudinal cohort study in which 293 people who'd had full body scans (mostly due to a suspected cancer diagnosis) were followed up for up to four years, to see whether they developed cardiovascular disease.

The second was a cross-sectional study of just 13 people, all of whom had previously had post-traumatic stress disorder (PTSD), in which the participants filled in a stress questionnaire and underwent body scans.

Neither study is able to show whether one factor (such as amygdala activity or stress) causes another, such as cardiovascular disease. However, they can flag up factors which are linked in some way, suggesting theories that can be tested in further research.

 

What did the research involve?

In the first study, researchers used data from body scans of 293 people, most of whom had been tested for cancer (although they did not have cancer at the time of the scan). The scan showed areas of activity and inflammation in the body and brain.

Researchers looked for links between activity in the amygdala of the brain, bone marrow, the spleen, and blood vessel inflammation. They then followed the people up for at least three years, to see if they developed cardiovascular disease.

In the second study, they asked 13 people with previous PTSD to fill in questionnaires about their perceived levels of stress. They then gave them body scans to look for evidence of activity in the amygdala, an inflammatory chemical called C-reactive protein, and levels of inflammation in the blood vessels. They looked to see whether these measures were linked to their stress scores.

The scanning technique used, F-fluorodexoyglucose positron emission tomography (F-FDG PET), involves injecting people with a type of sugar that shows up on scans, so the scan can show where it's being taken up by cells, and therefore which areas of the body are active or inflamed.

People in the first study weren't asked about their stress levels. They were only included if they had no history of cardiovascular disease, no active cancer, no inflammatory or autoimmune disease, and were over 30 years old.

They weren't checked directly for cardiovascular disease during the three to four years follow up. Instead, researchers looked at their medical records to see if any cardiovascular events such as stroke had occurred.

Researchers adjusted figures in the first study to take account of known risk factors for cardiovascular disease, including:

  • age
  • smoking
  • cardiovascular risk score
  • body mass index (BMI)
  • diabetes

 

What were the basic results?

Twenty-two people had one or more events of cardiovascular disease (including heart attack, stroke, unstable angina, first episode of angina, heart failure and peripheral arterial disease).

Higher activity in the amygdala was linked to an increased chance of having a cardiovascular event. The researchers calculated that each unit increase (standard deviation of amygdala activity increased the risk of cardiovascular disease 1.6 times – hazard ratio 1.6, confidence intervals not given). This link remained true after taking account of cardiovascular risk factors.

Activity in the amygdala was also linked to higher activity in the spleen and the bone marrow, which produce blood cells, and with higher inflammation of artery walls. Activity in the bone marrow was reflected in more white blood cells in the blood.

By analysing the statistics, researchers said bone marrow activity could account for almost half the link between amygdala activity and artery inflammation, and that artery inflammation accounted for 39% of the link between amygdala activity and cardiovascular events.

In the second study, activity in the amygdala was linked to people's perceived stress levels, artery inflammation and C-reactive protein levels.

 

How did the researchers interpret the results?

The researchers say they have shown "for the first time in human beings" that activity in the amygdala of the brain predicts the development of cardiovascular disease in years to come. They say this is linked to blood cell production and artery inflammation, and to perceived stress.

They say that clinicians treating people with stress related illnesses "could reasonably consider the possibility that alleviation of stress might result in benefits to the cardiovascular system," and that "eventually, chronic stress could be treated as an important risk factor for cardiovascular disease," which could be screened for and managed in the way high cholesterol or blood pressure are managed. 

 

Conclusion

This intriguing study sets out a possible pathway by which the effects of stress on the brain could translate into inflammation in the blood vessels, and so raise the risks of cardiovascular disease. This would help to explain why people living in stressful situations, or with illnesses such as depression and anxiety, are more at risk of heart attacks and strokes.

However, there are important limitations to the study which mean we should treat the findings with caution. The main study of 293 people was relatively small for a long-term study looking at cardiovascular disease, and only 22 people had a cardiovascular event. That means there's more likelihood of the results being down to chance.

The study mainly used patients being tested for cancer (either because they'd had it in the past, or were suspected of having it). That could mean their stress levels, amygdala activity and so on are not typical of people in the wider population. They were almost all white, so results may not apply to other ethnic groups.

Also, people in this group didn't have their stress levels tested, so we don't know whether raised amygdala activity in this group was a result of stress. That means we don't know whether people who had heart attacks or other cardiovascular events were more stressed – only that their amygdalae showed more activity on one occasion.

The cross-sectional study, which linked stress to amygdala activity, was very small. It only included people with a history of PTSD, so again we can't be sure these results would apply to a wider population.

So we need to see larger, longer-term studies to test this theory that stress causes cardiovascular disease via amygdala, bone marrow and arteries.

However, we already know that long-term stress is linked to poor health, both in terms of mental and physical health, so lack of evidence about the pathway should not stop us from trying to alleviate stress.

Read more advice about coping with stress and how breathing exercises can help you cope with feelings of acute stress and anxiety.

Links To The Headlines

Brain activity 'key in stress link to heart disease'. BBC News, January 12 2017

Scientists link stress to heart attacks and strokes in the brain for the first time. Daily Mirror, January 12 2017

How stress puts us at a higher risk of heart attack: Higher activity in certain part of the brain is linked to clotting in the aorta. Daily Mail, January 12 2017

Scientists finally discover how stress causes heart attacks and strokes. The Daily Telegraph, January 12 2017

Stress increases risk of heart attacks and strokes by nearly 60 per cent. The Sun, January 12 2017

Links To Science

Tawakol A, Ishai A, Takx RAP, et al. Relation between resting amygdalar activity and cardiovascular events: a longitudinal and cohort study. The Lancet. Published online January 11 2017

Study reveals how alcohol shifts brain into 'starvation mode'

"Alcohol switches the brain into starvation mode, increasing hunger and appetite, scientists have discovered," BBC News reports.

Research in mice found alcohol increased activity in a set of brain cells used to regulate appetite.

Scientists have long been puzzled about why people often eat more when they've been drinking alcohol, despite the high number of calories in alcoholic drinks. Alcohol is second only to fat in its calorie density.

The body's regulatory system should register calories arriving in the body, so that the person would not feel hungry. But with alcohol the opposite happens – people feel hungry and eat more.

Researchers found that mice ate more when given alcohol. They saw spikes in electrical activity in Agouti-related peptide cells (AGRP cells) from the mice brains when they were exposed to alcohol. AGRP cells are specialised brain cells the body uses to regulate appetite. While hunger may hit you in your stomach, the entire process of "hunger, eat, reward" is controlled by your brain.

When the mice's AGRP cells were chemically blocked, they no longer ate more when given alcohol.

Research in animals doesn't always translate to humans, so we don't know for sure if this means the same thing happens in human brains. However, it is plausible.

It's also a reminder that if you're trying to watch your weight – alcohol will set you back in more ways than one; it is chock full of calories in its own right, and it may well make you eat more on top. 

 

Where did the story come from?

The study was carried out by researchers from the Francis Crick Institute and University College London and was funded by the Francis Crick Institute, which itself is funded by Cancer Research UK, the UK Medical Research Council, and the Wellcome Trust.

The study was published in the peer-reviewed journal Nature Communications, on an open-access basis so it is free to read online.

The BBC summarised the results reasonably accurately, saying that while the research was in mice, the researchers "believe the same is probably true in humans".

But the Daily Mail barely mentioned that the research was carried out in mice, and that animal research does not necessarily translate into humans.

 

What kind of research was this?

This was experimental animal research, carried out in a laboratory on mice bred for experimental purposes. While animal research can give us clues to what may be happening in human bodies, there are plenty of differences between mice and humans. This means we can't rely on the results being true for humans.

 

What did the research involve?

Scientists carried out a series of experiments on laboratory mice, to see what effect ethanol (pure alcohol) had on their eating behaviour and brain cells. They examined tissue from mice brains, to see how certain brain cells responded to ethanol, and looked to see what happened when they blocked receptors for those cells.

The first experiments included giving 10 mice the mouse equivalent of 18 human units of alcohol a day (about a standard bottle and a half of wine) for three days. The alcohol was given by injection into the body, to ensure all mice got the same amount and that their appetites weren't affected by the taste. Researchers weighed how much food the mice ate each day. This was compared to food eaten on the days before and after the alcohol dose.

They then took brain samples from genetically modified mice and looked to see what effect ethanol had on AGRP nerve cells from the hypothalamus of the brain. They used calcium activity markers (a technique that helps brain activity to show up on brain scans) and measured electrical activity. They also blocked AGRP cells using chemicals, and looked to see what effect that had on brain cells and on mice eating habits, with and without alcohol.

 

What were the basic results?

The mice ate between 10% and 25% more food on the days when they'd been given ethanol. This dropped back down to previous levels after the alcohol was stopped.

Experiments on brain tissue showed that AGRP cells were activated and had spikes in electrical activity when exposed to alcohol.

When the researchers blocked the mice's AGRP cells with an inert drug, alcohol no longer had an effect on how much the mice ate. Blocking the cells, without alcohol, made less difference to how much they ate, suggesting that the interplay of AGRP and alcohol was what affected the mice's eating most strongly.

 

How did the researchers interpret the results?

The researchers suggest that the alcohol-associated activity of the AGRP brain cells "is the critical step in alcohol-induced overeating".

They say their findings "provide an explanation for how a commonly consumed nutrient [alcohol] may generate a positive feedback on energy intake," and that this may help doctors better understand over-eating leading to ill-health in humans.

 

Conclusion

Alcohol is no friend of people trying to lose weight, or stick to a healthy weight. Not only is it high in calories (the second most energy-dense nutrient after fat), but it tends to be linked to a desire to eat more.

Scientists have suggested various theories to explain this. One theory is that alcohol erodes willpower, meaning people are likely to eat more than they intended after a drink. That could also explain why people often pick less healthy options, such as crisps or kebabs, if they've been drinking.

This new research suggests an alternative explanation – that the specific effect of alcohol on brain cells could trigger "an attack of the munchies".

But while the results seem reasonably convincing for mice, we still don't know if they hold true for humans. Also, rather than drinking it, the mice were given injections of alcohol, which might have a different effect.

Even so, the research is a reminder that alcohol and overeating can go hand in hand. If you're planning on shifting a few pounds in 2017, cutting back on alcohol, or avoiding it entirely, could be a positive first step.

In the UK, the government recommends that men and women drink no more than 14 units of alcohol a week. That is:

  • nine small glasses of average strength wine
  • seven pints of average strength beer or lager
  • 14 single measures of spirits

The advice is to spread those units over three or more days, and to have several alcohol-free days each week.

Read more tips about cutting down on your alcohol intake.

Links To The Headlines

Alcohol flips brain into hungry mode. BBC News, January 10 2017

How wine before dinner makes you eat more: 'Aperitif effect' puts your brain into starvation mode. Daily Mail, January 11 2017

Links To Science

Cains S, Blomeley C, Kollo M, et al. Agrp neuron activity is required for alcohol-induced overeating. Nature Communications. Published online January 10 2017

Weekend-only workouts 'still give an important health boost'

"Weekend warriors, take a victory lap. People who pack their workouts into one or two sessions a week lower their risk of dying over roughly the next decade nearly as much as people who exercise more often," the Mail Online reports.

New research looked at data from almost 64,000 participants collected as part of health surveys for England and Scotland from 1994 to 2012.

Researchers were particularly interested in what have been termed "weekend warriors": adults who only exercise at the weekend.

They placed participants into four groups based on how much and how often they exercised: inactive, insufficiently active, weekend warriors, and regularly active.

Compared with people who did no physical activity, all active groups – including insufficient activity, regular activity and weekend patterns – saw a reduction in their risk of death from any cause or cardiovascular disease.

But weekend activity had no significant effect on reducing cancer risk, unlike the people in the regularly active groups, and surprisingly the insufficiently active group.

While this large and reliable study is unable to prove cause and effect, the results do seem to confirm the Mail's headline: "It's all good: Any exercise cuts risk of death, study finds".

Read more about how you can fit exercise into your day-to-day regime without having to go to the gym.

Where did the story come from?

The study was carried out by researchers from the University of Leicester, Loughborough University, University College London and the University of Sydney.

Funding was provided by the National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care–East Midlands, Leicester Clinical Trials Unit, and the NIHR Leicester-Loughborough Diet, Lifestyle and Physical Activity Biomedical Research Unit.

It was published in the peer-reviewed journal JAMA Internal Medicine on an open access basis, so you can read it free online.

This study has been widely covered by the UK media, but there were some inaccuracies with the reporting.

BBC News states weekend warriors were found to lower their risk of dying from cancer by 18% compared with the inactive group, but this finding was not statistically significant, so it could have been the result of chance.

The Daily Mirror repeats this error while making the mistake of putting it in its headline: "People who exercise just once or twice a week reduce their risk of dying from cancer by 20%, according to a new study". 

What kind of research was this?

This survey aimed to investigate associations between leisure time physical activity patterns and mortality, overall and from specific cardiovascular and cancer causes.

Themes can be identified in this type of study, but it is difficult to have a good level of certainty in the findings.

Surveys are subject to recall bias and cannot prove cause and effect, as unmeasured health and lifestyle factors may be involved in the links.

What did the research involve?

The researchers pooled data from adults aged 40 years or older collected as part of the Health Survey for England and the Scottish Health Survey. Data was collected between 1994 and 2012.

Participants met with trained interviewers and were asked about their level of physical activity using an established questionnaire.

Data was gathered on the participants' physical activity in the four weeks before the interview, and included:

  • frequency and duration of participation in domestic physical activity
  • frequency, duration and pace of walking (slow, average, brisk or fast)
  • participation in sports and exercises (such as cycling, swimming, running) and the associated frequency, duration and perceived intensity

Based on the findings, the patterns of physical activity were defined as:

  • inactive – not reporting any moderate- or vigorous-intensity physical activities
  • insufficiently active – less than 150 minutes a week of moderate-intensity physical activity and less than 75 minutes a week of vigorous-intensity physical activity
  • weekend warrior – at least 150 minutes a week of moderate-intensity physical activity or at least 75 minutes a week of vigorous-intensity physical activity from one or two sessions
  • regularly active – at least 150 minutes a week of moderate-intensity physical activity or at least 75 minutes a week of vigorous-intensity physical activity from three or more sessions

In addition to questions on physical activity, the interviewers gathered information on illness, occupation and ethnicity.

Socioeconomic status was established from participants' occupations. The trained interviewers also measured height, weight, and body mass index (BMI).

Causes of death were obtained from death certificates.

What were the basic results?

A total of 63,591 participants were included in the study, with an average age of 58.6 years.

During the follow-up period there were 8,802 deaths from all causes, 2,780 deaths from cardiovascular disease, and 2,526 from cancer.

When compared with inactive participants in the study, the risk of death from any cause was lower for all other activity groups:

  • 34% lower for insufficiently active participants (hazard ratio [HR] 0.66, 95% confidence interval [CI], 0.62 to 0.72)
  • 30% lower for weekend warriors (HR 0.70, 95% CI, 0.60 to 0.82)
  • 35% lower for regularly active participants (HR 0.65, 95% CI, 0.58 to 0.73)

Compared with inactive participants, any level of activity reduced risk of death from cardiovascular disease by around 40%:

  • insufficiently active participants (HR 0.60 (95% CI, 0.52 to 0.69)
  • weekend warriors (HR 0.60 (95% CI, 0.45 to 0.82)
  • regularly active participants (HR 0.59 (95% CI, 0.48 to 0.73)

Compared with the inactive participants, the risk of death from cancer was significantly reduced for insufficiently active (HR 0.83, 95% CI, 0.73 to 0.94) and regularly active participants (HR 0.79, 95% CI, 0.66 to 0.94), but the risk was not significantly lower for weekend warriors (HR 0.82, 95% CI, 0.63 to 1.06). 

When comparisons were drawn with the insufficiently active group, no benefit was seen for weekend warriors for all causes of death, death from cardiovascular disease, or death from cancer.

Those who were regularly active saw a reduction in causes of death and death from cancer.

How did the researchers interpret the results?

The researchers concluded that, "Weekend warrior and other leisure time physical activity patterns characterised by one or two sessions per week may be sufficient to reduce all-cause, CVD [cardiovascular disease], and cancer mortality risks regardless of adherence to prevailing physical activity guidelines." 

Conclusion

This survey aimed to investigate patterns of physical activity in adults over the age of 40 and the potential impact on their cause of death.

The study found that, compared with those who were not physically active, all active groups saw a reduction in their risk of death from any cause and cardiovascular disease. Being active at the weekend only had no effect on cancer mortality.

However, interpretations around the optimal level of activity are difficult when you note that insufficient activity gave similar mortality reductions as the recommended regular activity.

This study has both strengths and limitations. It is a very large study and data was collected using validated tools and other reliable sources.

The main limitation, however, is it's not able to prove that the amount of exercise taken is responsible for any reductions in risk of death.

There may be a number of unmeasured health, lifestyle and sociodemographic factors at play here.

Also, the weekend warriors only made up a small proportion of the total study population at 3.9%.

Analyses involving smaller numbers of people are less reliable, and this may have been why some of the findings were significant and others not. It's hard to be sure that these are reliable estimates.

The study also only looked at links with cardiovascular and cancer deaths – not at diagnoses of these conditions.

The research team acknowledged a number of other limitations themselves:

  • Most of the participants were white, which may reduce the generalisability of the findings to other ethnic groups.
  • Physical activity was only assessed at the start of the study, and this may have changed during the study period.
  • Self-reported information on physical activity is subject to recall bias – though in this case participants only had to recall the past four weeks.
  • Occupational physical activity was not formally assessed, and this may have an effect on the findings.
  • Reverse causation is possible in this type of study: that is, participants with an illness that may increase mortality risk are less likely to be active.

Current physical activity guidelines for adults advise taking 150 minutes of moderate activity a week and doing strength exercises on two or more days a week that work all the major muscles (legs, hips, back, abdomen, chest, shoulders and arms).

Meeting these guidelines could reduce the risk of major illnesses, such as heart disease, stroke, type 2 diabetes and cancer.

Links To The Headlines

It's all good: Any exercise cuts risk of death, study finds. Mail Online, January 9 2017

Weekend exercise alone 'has significant health benefits'. BBC News, January 10 2017

Weekend workouts can benefit health as much as a week of exercise, say researchers. The Guardian, January 9 2017

Why you only need to work out at the weekend to keep yourself healthy. Daily Mirror, January 9 2017

Links To Science

O'Donovan G, Lee I, Hamer M, et al. Association of "Weekend Warrior" and Other Leisure Time Physical Activity Patterns With Risks for All-Cause, Cardiovascular Disease, and Cancer Mortality. JAMA Internal Medicine. Published online January 9 2017

Reports of a 'wrinkle cure' look a little saggy

"Wrinkles could be a thing of the past as scientists find a way to regenerate fatty cells," The Daily Telegraph reports.

Research involving mice suggests a protein called bone morphogenetic protein (BMP) could repair skin damaged by scarring or ageing by stimulating the production of fat cells (adipocytes).

The research team wanted to investigate why mice that experience skin damage are able to produce new fat cells during the healing process. The same is not true for humans where injury results in some degree of scarring.

Human skin also loses its elasticity over time – leading to wrinkles – due to the gradual loss of adipocytes.

The researchers found the answer appears to lie in hair follicles. When the mouse wounds heal they produce new hair follicles (tiny sacs in the surface of the skin that anchor individual hairs). This in turn triggers the production of BMP which appears to cause damaged skin tissue to be "reprogrammed" into fat cells.

The researchers hope their findings may be used to develop new treatments to treat scar tissue in humans, and possibly (and likely much more profitably) reverse the signs of ageing.

But exactly how you safely replicate biological processes innate to rodents in humans is just one of the many wrinkles that will need to be ironed out before we can realistically start talking about an "elixir of youth".

 

Where did the story come from?

The study was carried out by researchers from University of Pennsylvania, University of California–Irvine, and various other institutions in the US and Europe. Funding was provided by the National Institutes of Health and the Edward and Fannie Gray Hall Center for Human Appearance, with individual researchers receiving grant support from several other sources.

The study was published in the peer reviewed scientific journal, Science.

The UK media over-hyped the implications of a very early-stage, lab based piece of research that involved no humans. Also, the fact that the work could possibly lead to an effective treatment for scarring was largely overlooked in favour of the potential for anti-ageing products.

However, it would appear that much of this hype was generated by the lead author of the study, Professor George Cotsarelis, who is widely quoted as saying: "Our findings can potentially move us toward a new strategy to regenerate adipocytes in wrinkled skin, which could lead us to brand new anti-ageing treatments."

 

What kind of research was this?

This was a laboratory study observing how wounds in mouse skin heal.

When wounds heal in humans they produce a scar with excess collagen but lacking in hair follicles and fat. Recent studies in mice have found that when wounds heal in mice they regenerate hair follicles which have fat cells (adipocytes) surrounding them. The adipocytes prevent scar wounds appearing in mice.

This study aimed to look into the repair mechanisms more closely and look at the cellular origin of the new fat cells. In particular they wanted to see if hair follicles were necessary for fat cells to form.

 

What did the researchers do?

The study involved conducting tests on mouse scar tissue in the laboratory. They cultured skin cells isolated from wounds to observe how they changed in the days and weeks following injury, looking at when the first new hair follicles appeared and when new fat cells appeared.

The researchers then looked into the cellular origins of the new fat cells and the processes that led to their development. They followed up their findings by looking at human scar tissue.

 

What did they find?

The researchers found that hair follicles seem to be necessary for new fat cells to form.

In mouse wounds new hair follicles started to form around 15 to 17 days after injury, followed by the first new fat cells at around 23 days, which then gradually increased in number.

In scar tissue with hair follicles many fat cells were seen, whereas none were seen in hairless scars.

Looking into the cellular origins of the fat cells, they seem to originate from myofibroblast cells – a cell type somewhere inbetween two cell types – fibroblasts, which are found in scar tissue, and smooth muscles cells. Therefore the origin of the fat cells was from a non-fat cell source.

New hair follicles seem essential to this myofibroblast reprogramming. New hair follicle formation triggers the release of the bone morphogenetic protein (BMP) which "kickstarts" the myofibroblast reprogramming. They demonstrated this process by using chemicals to block BMP signalling and found that fat cells did not form.

In their further laboratory tests in human scar tissue the researchers demonstrated they could form fat cells in the tissue in two ways: if they either treated the scar tissue (fibroblasts) with BMP, or alternatively cultured them with hair follicles. 

 

What did the researchers conclude?

The researchers conclude: "We identify the myofibroblast as a plastic cell type that may be manipulated to treat scars in humans."

 

Conclusions

This laboratory study furthers understanding of how wounds heal. It found that mouse skin wounds are able to regenerate new fat cells through signalling pathways triggered when new hair follicles form.

The researchers hope their findings may be developed and offer potential new ways to treat scar tissue in humans, enabling them to produce new fat cells that are normally lacking in a scar formed of connective tissue cells – hopefully ultimately improving the appearance of scars and making them look like normal skin.

And, as the media seized upon, there may be the possibility of repairing the effects of ageing on the skin.

However, a great deal more study would be needed to develop these findings, and see if they could be applied in the real world, rather than in the laboratory.

Links To The Headlines

Wrinkles could be a thing of the past as scientists find way to regenerate fatty cells which keep skin looking youthful. The Daily Telegraph, January 8 2017

Have scientists found elixir of youth to undo our wrinkles? Regenerating fatty cells could mean crow's feet and creases can be reversed. Daily Mail, January 9 2017

New anti-ageing treatment ERASES wrinkles ‘regenerating fat cells to plump the skin’. The Sun, January 9 2017

A cure for wrinkles? Body reveals smooth skin secret. The Times, January 9 2017 (subscription required)

Links To Science

Plikus MV, Guerrero-Juarez CF, Ito M, et al. Regeneration of fat cells from myofibroblasts during wound healing. Science. Published online January 5 2017

Some babies should be given peanuts early say new US guidelines

"Babies should be given peanut early – some at four months old – in order to reduce the risk of allergy, according to new US guidance," BBC News reports. The guidelines are based on UK-led research that found early exposure reduced allergy risk.

The new US guidelines, which are informed by expert panel discussions and a new UK study, suggest that if an infant has severe eczema or an egg allergy, peanuts may be introduced at around four to six months. And that waiting later may increase the risk of an allergy developing.

However, they suggest checking with a health professional first if the infant does have these severe allergies.

For babies with no signs of allergies or mild to moderate eczema the new US guidelines recommend that peanuts can be introduced without seeking medical advice.

Current UK guidelines say that if your child already has an allergy (such as eczema or a diagnosed food allergy), or there's a family history of allergy, you should get medical advice before giving them peanuts for the first time. See Food allergies in babies.

If there's no history of food allergies or other allergies in your family, UK guidelines say you can give your baby peanuts from the age of six months, as long as they're crushed or ground into peanut butter. Whole nuts, including peanuts, shouldn't be given to children under five as they can choke on them. See Food to avoid giving your baby.

 

Who produced the guidelines?

The guidelines were produced by the National Institute of Allergy and Infectious Diseases, part of the Department of Health and Human Services, National Institutes of Health in the US.

 

What evidence did they look at?

Despite the guidelines being for the US, they are actually based on research from the UK; specifically a clinical trial called the Learning Early About Peanut Allergy (LEAP).

LEAP was a randomised controlled trial (RCT) involving 600 children aged between 4 and 11 months with severe eczema, egg allergy or both. The babies were randomised to eat or avoid peanut-containing foods (but not whole nuts) until 60 months of age.

At the age of five the children were given a "peanut oral food challenge" which involves exposing the mouth to a small amount of peanuts (2 to 3.9g) to see if there was any allergic reaction(s).

The researchers found that regular consumption of peanut-containing foods in early life reduced the risk of developing a peanut allergy by 81%.

We discussed this study in detail in February 2015.

Along with this evidence, the guideline committee also carried out a literature review of recent research and asked an expert panel, consisting of 26 experts from clinical, public health and scientific backgrounds, to contribute to the guidelines.

 

What are the main recommendations?

Based on the evidence considered by the authors, three guidelines have been produced:

  • Guideline one – designed for parents who know their infant has severe eczema, egg allergy or both.
  • Guideline two – designed for parents who know their infant has mild to moderate eczema.
  • Guideline three – designed for parents who have an infant with no history of eczema or food allergies.
Guideline one

Peanut-containing foods should be introduced as early as 4-6 months for infants with severe eczema, egg allergy or both.

However, parents should check with the doctor in charge of their child's care before feeding them peanut-containing food.

In some cases an allergy test may be needed to determine if peanut should be introduced and the safest way of doing so. The suggested amount to introduce is around 6 to 7 grams per week, divided over three feeds.

Guideline two

For infants with mild to moderate eczema, peanut-containing foods should be introduced around six months to reduce risk of developing a peanut allergy. This should be done in line with the family's dietary preferences – if peanuts are not part of everyday diet, they do not have to be introduced at such an early stage.

Guideline three

For infants with no eczema or food allergy, peanut-containing foods can be introduced freely into their diet. This can be done at home in an age-appropriate manner, along with other solid foods.

 

How have independent experts received the guidelines?

As these are US guidelines, the current official UK guidelines on peanuts and diet are currently unchanged. UK advice is:

  • If your baby already has an allergy (such as eczema or a diagnosed food allergy), or there's a family history of allergy, you should get medical advice before giving them peanuts for the first time. See Food allergies in babies.
  • If there's no history of food allergies or other allergies in your family, you can give your baby peanuts from the age of six months, as long as they're crushed or ground into peanut butter. Whole nuts, including peanuts, shouldn't be given to children under five as they can choke on them. See Food to avoid giving your baby.

That said, many UK experts have welcomed the new US guidelines.

Michael Walker, member of the European Academy of Allergy and Clinical Immunology said: "The guidelines are based on sound medical research carried out in the UK. For infants with severe eczema or egg allergy or both, and thus most at risk, the guidelines suggest clinical tests before a decision to introduce peanut-containing foods. Infants at less risk, e.g. mild eczema, or no eczema, can receive peanut-containing food from about 6 months, subject to family preferences and cultural norms. This is sensible advice that I am sure UK authorities will wish to think about."

He recommends parents in the UK should consult their GP, bringing to attention these US guidelines before attempting peanut allergy prevention in their own infant.

Alastair Sutcliffe, a Professor of Paediatrics at UCL also welcomes these new US guidelines. He said "the USA leads as is often the case where others follow and I, as a practicing paediatrician, welcome this new guidance".

However, Prof. Alan Boobis, Professor of Biochemical Pharmacology at Imperial College London, pointed out that: "The implications of these findings, with the possible introduction of solid food prior to 6 months, are complex."

The advice is currently being reviewed by the Department of Health and a related report is expected in the first half of the year.

Links To The Headlines

Give peanut to babies early – advice. BBC News, January 5 2017

Give babies peanut-based foods early to prevent allergies, doctors suggest. The Guardian, January 5 2017

Give your child peanuts at FOUR MONTHS, new guidelines say: Drastic change in medical advice insists earlier exposure will prevent allergies. Daily Mail, January 6 2017

Children need peanuts from early age to prevent allergy, new guidance says. The Daily Telegraph, January 5 2017

Revealed: How parents can stop their children developing a deadly nut allergy. Daily Mirror, January 5 2017

Links To Science

Togias A, Cooper SF, Acebal ML, et al. Addendum guidelines for the prevention of peanut allergy in the United States: Report of the National Institute of Allergy and Infectious Diseases–sponsored expert panel (PDF 371kb). The Journal of Allergy and Clinical Immunology. Published online January 5 2017

National Institute of Allergy and Infectious Diseases. Addendum Guidelines for the Prevention of Peanut Allergy in the United States - Summary for Parents and Caregivers (PDF 262kb). January 2017

People who live near busy roads have higher dementia rates

"People who live near major roads have higher rates of dementia," BBC News reports.

A Canadian study found that people who lived within 50 metres of a busy road were 7% more likely to develop dementia than people who live at least 300 metres away.

The results were produced by a major study that tracked all adults in Canada's most populated province (Ontario) over 11 years.

Researchers also looked to see if a similar pattern was found with two other neurological conditions; Parkinson's disease and multiple sclerosis. They found no evidence of any link.

This study of 6.8 million people adds to evidence that living close to heavy traffic may have an effect on dementia. A study we discussed last year found evidence that particles caused by air pollution can physically make their way into human brains.

While this type of study cannot prove that traffic or air pollution has caused the increase in dementia cases, a link is certainly in the realms of scientific possibility. Air pollution caused by traffic can lead to exposure to a wide range of damaging toxins, such as nitrogen oxides.

Exactly what policy makers can do to reduce any potential risk of exposure remains a matter of debate.

On an individual basis, there's not much you can do if you live near a busy road, especially if you're in a city where most people live near busy roads. However, it does make sense to reduce your exposure to pollution if you can, for example by walking on the further side of the pavement, and exercising in parks or back streets.

 

Where did the story come from?

The study was carried out by researchers from a number of Canadian institutions: Public Health Ontario, Institute for Clinical Evaluative Services, University of Toronto, Dalhousie University, Oregon State University, Health Canada, and Harvard-Smithsonian Centre for Astrophysics in the US.

It was funded by Public Health Ontario and the Institute for Clinical Evaluative Services. The study was published in the peer-reviewed journal The Lancet.

The study was widely reported in the UK media on a broadly accurate basis. Most stories included warnings from independent experts that the study cannot show the cause of the increased number of dementia cases, although you have to read quite far down in most cases to see this explanation.

 

What kind of research was this?

This was a cohort study which tracked adults in the province of Ontario for up to 12 years. It looked at how close they lived to a main road five years before the study began, then tracked diagnoses of dementia, Parkinson's disease and multiple sclerosis.

This type of study can show links between factors such as proximity to busy roads and chances of getting illnesses, but it can't prove that one causes another.

 

What did the research involve?

Researchers studied health information from 6.8 million adults aged 20 to 85 in Ontario, Canada's most populous province, from 2001 to 2012.

The researchers recorded diagnoses of dementia and Parkinson's disease in people aged 55 to 85. They also recorded any diagnosis of multiple sclerosis (MS) in people aged 20 to 50 (symptoms of MS typically begin earlier than dementia and Parkinson's).

They recorded people's post code from their address in 1996, five years before the study start, and divided them into groups living within 50 metres, 50 to 100 metres, 101 to 200 metres, 201 to 300 metres, or further, from a major road.

They used information from Canadian health databases, which record diagnoses and treatments. Major roads were defined as "a major thoroughfare with medium to large traffic capacity".

They adjusted the figures to take account of the following potential confounding factors:

  • age and sex
  • pre-existing illnesses (people who already had dementia, Parkinson's disease or MS were not included in the study)
  • whether people lived in urban or rural areas
  • exposure to air pollutants using neighbourhood figures for nitrous oxide (NO2) and small particulate matter (PM2.5)

Because they didn't have information on people's individual risk factors for dementia, such as smoking, education level, physical activity and socioeconomic status, they used neighbourhood-level figures, such as average income, to estimate these individual risk factors.

They also looked at access to neurologists, which might affect people's chances of being diagnosed, and how far north or south they lived (as this has an effect on multiple sclerosis).

 

What were the basic results?

More than half of the 6.8 million people in the study lived within 200 metres of a major road. There were many more diagnoses of dementia than of MS or Parkinson's disease in the 12-year study:

  • 243,611 people developed dementia
  • 31,577 people developed Parkinson's disease
  • 9,247 people developed MS

Researchers found no link between where people lived and how likely they were to get MS or Parkinson's disease. However, this could have been because fewer cases make it harder to get a picture of a trend.

Dementia was linked to where people lived. Compared to living more than 300 metres from a major road:

  • those living less than 50 metres away had a 7% increased risk (hazard ratio (HR) 1.07, 95% confidence interval (CI) 1.06 to 1.08)
  • those living within 50 to 100 metres had a 4% increased risk (HR 1.04, 95% CI 1.02 to 1.05)
  • those living within 101 metres to 200 metres had a 2% increased risk (HR 1.01 to 1.03)

Living more than 200 metres away did not increase risk. Looking at other factors, those in urban areas were more at risk. Levels of air pollution (NO2 and PM2.5) explained some of the increased risk associated with living close to a busy road, but not all of it.

 

How did the researchers interpret the results?

The researchers said the study provides "important insights into a possible role of near-road exposure on the development of dementia". They say that even though a 7% increase in risk is small, because of the numbers of people getting dementia and the numbers living in towns and cities, "even a modest effect from near-road exposure can pose an enormous health burden."

 

Conclusion

Dementia is a growing problem as more people live longer. We don't yet know exactly how it develops, and it seems likely that a number of factors affect a person's chances of getting it, including genetics, lifestyle and other environmental factors.

This study seems to add to evidence that something about living near busy roads – whether it be air pollution, noise or other unknown factors – also has an effect on the chances of getting dementia. There are several limitations to be aware of, however:

  • the study only looked at where people lived at one point in time, and we don't know how well that represents their exposure to road noise or air pollution over the 12 year study period
  • we don't know how people's individual behavioural risks might have affected the results. For example, people living near busy roads might take less physical exercise than those living in quieter areas
  • some people with dementia or other diseases might not have been diagnosed

Overall, this is a very large study which adds to concerns over pollution and health. Governments and health authorities should be aware of this research when putting together plans to tackle air pollution and when planning roads and housing.

On an individual basis, there's not much you can do if you live near a busy road, especially if you're in a city where most people live near busy roads. However, it does make sense to reduce your exposure to pollution if you can, for example by walking on the further side of the pavement, and exercising in parks or back streets.

Although nothing guarantees that you won't develop dementia, there are plenty of things you can do that may help delay the onset of the condition:

Read more about preventing dementia.

Links To The Headlines

Dementia rates 'higher near busy roads'. BBC News, January 5 2016

Live on a busy road? Then you're SIGNIFICANTLY more likely to develop dementia, shock study finds. Daily Mail, January 5 2016

Living near heavy traffic increases risk of dementia, say scientists. The Guardian, January 5 2016

Living near major roads can increase risk of dementia, says study. The Independent, January 5 2016

Living close to a busy road may 'raise the risk of dementia'. ITV News, January 5 2016

Links To Science

Chen H, Kwong JC, Copes R, et al. Living near major roads and the incidence of dementia, Parkinson's disease, and multiple sclerosis: a population-based cohort study. The Lancet. Published online January 4 2016

Does discovery of 'severe PMS genes' offer hope of a cure?

"Women who suffer from severe mood swings before their period have a different genetic make-up," The Sun reports.

New research has found a link between a gene complex called ESC/E(Z) and severe symptoms of premenstrual syndrome, known as premenstrual dysphoric disorder (PMDD).

Nearly all women of childbearing age have some premenstrual symptoms – often referred to as PMS or PMT.

But PMDD only affects around 1 in 20 women, and its symptoms – such as depression and extreme anxiety – can be severe enough to disrupt day-to-day life. Many women with PMDD need medication to help.

Scientists found cells from women with PMDD respond differently to the hormones oestrogen and progesterone than cells from other women.

They identified differences in the genes expressed in the cells, both before and after they were exposed to the hormones.

Although the researchers say a particular group of genes called ESC/E(Z) complex were involved, they don't know exactly how this affects PMDD symptoms.

They say this is the first time scientists have shown a difference between women with and without PMDD at a cellular level. This suggests the condition might have an inherited basis.

But they stress that we need to be cautious about the biological relevance of these findings.

Any treatments that target hormonal responses run the possibility of triggering a wide range of side effects.

So a realistic answer to the question in our headline? "A cure is probably a long way off." 

Where did the story come from?

The study was carried out by researchers from the US National Institutes of Health and the University of North Carolina, and was funded by the National Institutes of Health. 

It was published in the peer-reviewed journal, Molecular Psychiatry.

This is a complex story and some media sources handled it better than others. The Independent gave a good overview.

Both The Daily Telegraph and the Daily Mail confused premenstrual dysphoric disease (PMDD), a severe form of PMS, with the outdated term premenstrual tension (PMT), both saying that scientists have discovered an explanation for why some women get PMT.

They also overstated the significance of the findings, which the researchers themselves said need to be confirmed and investigated further.

What kind of research was this?

The researchers began with a case-control study to identify how women with and without diagnosed PMDD responded to hormones.

They then took blood from the women to grow cultures of white blood cells, which they genetically sequenced before and after exposure to hormones.

Case-control studies can point to differences between groups (in this case, women) but can't explain what causes them.

Experiments on cells can point to interesting avenues for further research, but in isolation they don't show us how the cells interact with the body as a whole.

The researchers used blood cells, but we don't know whether cells in the brain and nervous system, for example, would react in the same way.

What did the research involve?

Researchers recruited 34 women with and 33 women without PMDD.

A small number from each group (10 with and 9 without PMDD) took part in a six-month study where they were given sex hormone blockers (drugs that reduce the effect of sex hormones) to see what effect it had on their moods. The blockers were then discontinued.

This was to confirm that the sex hormones in question – oestrogen and progesterone – had little effect on women without PMDD, but a big effect on symptoms of women with PMDD.

The researchers then took blood samples from all the women, cultured their white blood cells and used ribonucleic acid (RNA) sequencing to look at how the cells responded to hormones.

They first checked that white blood cells expressed the sex receptor genes necessary to respond to oestrogen and progesterone.

Then they sequenced messenger RNA (mRNA) from the cells to look for differences between that of women with and without PMDD. mRNA carries messages from the DNA in the cell nucleus to the cell, where proteins are formed.

They repeated the sequencing in cells that had been exposed to oestrogen and progesterone for 24 hours.

The researchers then focused on differences found in the ESC/E(Z) complex of genes, as previous research had shown this might play a role in hormone-related mood disorders.

They looked at which genes were switched on and off, how this differed between cells from women with and without PMDD, and what effect this had on protein formation.

What were the basic results?

The researchers found:

  • Women with PMDD had improved symptoms while taking a hormone blocker (the gonadotrophin-releasing hormone receptor agonist leuprolide), but their symptoms returned when given oestrogen or progesterone.
  • More genes from the ESC/E(Z) complex were "switched on" in cells from women with PMDD, but the genes were less likely to prompt the formation of proteins.
  • When the researchers added oestrogen and progesterone to the cells, some genes were switched on in women with PMDD that were switched off in women without, and vice versa.
How did the researchers interpret the results?

The researchers said: "We think that the cellular difference we found captures an important component of vulnerability to PMDD", but warned that there are "many important elements" in the nervous system that cannot be seen in the blood cells.

They say that the "biological relevance" of their findings "should be interpreted cautiously" until future studies have outlined more clearly the role of the ESC/E(Z) complex genes in PMDD.

Conclusion

PMDD can make life extremely difficult. While hormone treatments and antidepressants help some women, you can't use hormone treatments if you're trying to get pregnant, and they have side effects that mean they're not suitable for everyone.

Finding out more about the condition is a first step to understanding it, and might lead to better treatments in the long term.

This early-stage research shows that the genetic make-up and response cells have to hormones may have a hand in how likely women are to get PMDD.

But we're a long way from knowing for sure if these cell responses are actually a cause of PMDD.

It's possible that the differences seen by the researchers might be the result of reverse causality – in other words, having a long-term mood disorder has shaped how the cells respond to hormones, rather than the other way around.

The groups in this study were not matched in terms of previous history of a major depressive episode, which had occurred in a quarter of women with PMDD.

And as this was not a randomised controlled trial, there may have been other unmeasured differences between the two groups that could account for the differences seen.

Because the researchers only looked at a small number of women with PMDD, we don't know if this research has any relevance to the much more common premenstrual syndrome (PMS), which includes symptoms of irritability, breast tenderness, mood swings and bloating.

The researchers say "it would only be a matter of speculation" to suggest these findings could apply to PMS.

If you have premenstrual symptoms that are making everyday life difficult, see your GP. Lots of treatments are available.

Read more about treatments for premenstrual symptoms.

Links To The Headlines

Women who suffer mood swings before periods 'have different genetic make-up'. The Sun, January 4 2017

Women's genes change during PMT, scientists find, raising hope for cure. The Daily Telegraph, January 4 2017

Do YOU have the angry gene? Scientists discover why some women are more prone to PMT. Mail Online, January 3 2017

Links To Science

Dubey N, Hoffman JF, Schuebel K, et al. The ESC/E(Z) complex, an effector of response to ovarian steroids, manifests an intrinsic difference in cells from women with premenstrual dysphoric disorder. Molecular Psychiatry. Published online January 3 2017

No proof that sugar-free soft drinks are healthier, argues review

"Soft drinks made with artificial sweeteners, such as diet colas, do not help people lose weight and may be as big a part of the obesity problem as the full-sugar versions," The Guardian reports.

While the headline may sound definitive, this was the conclusion of an opinion piece (or narrative review), not evidence based on new research.

The big food and drink manufactures have responded to increasing concerns about the impact of sugar-sweetened beverages on health, such as increasing rates of tooth decay and type 2 diabetes, by promoting artificially sweetened drinks as a healthy alternative.

However, recent evidence suggests these may not actually be a better option, and this review wanted to look into this further.

The review argues that artificially sweetened drinks are just as bad as sugar sweetened drinks and says that the national dietary guidance shouldn't recommend consumption of artificially sweetened drinks as an alternative.

The review concludes there is an "absence of consistent evidence" that artificially sweetened drinks can improve health outcomes such as helping people achieve a healthy body weight. But absence of evidence is not the same as evidence of absence. Due to the unsystematic nature of the review we can't be sure all relevant evidence was considered.

 

Where did the story come from?

The review was carried out by researchers from various institutions in the UK, US and Brazil, such as Imperial College London, Washington University in St. Louis and the University of São Paulo. Individual researchers reported various sources of funding, including the Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq) and an NIHR Research Professorship award.

The review was published in the peer-reviewed medical journal PLOS Medicine, an open-access journal, so the study is free to read online.

As expected, the UK media jumped on the claims that "diet drinks" should not be seen as the healthier option. But most sources gave the mistaken impression, at least in the headlines, that this was new research as opposed to a review of existing evidence.

However, most did delve into the limitations of the review further down in their reports.

 

What kind of research was this?

This was an evidence-informed narrative review which assembled data from various avenues of research. The review explored the hypothesis that artificially-sweetened drinks aren't actually a better option than sugar-sweetened drinks.

The researchers assessed evidence from different types of study such as randomised-controlled trials (RCTs) and observational studies. They also discussed some of the strengths and limitations associated with each study design.

The methods behind how the literature was identified weren't described; there wasn't mention of whether databases were searched or criteria for inclusion and exclusion. As such, it isn't possible to say whether the review was carried out in a systematic manner.

Non-systematic reviews are useful for summarising research on a particular topic, but run the risk of missing counterarguments and other relevant evidence.

 

What did they find?

The review starts by providing some background on sugar sweetened and artificially sweetened drinks and their suspected links with the global obesity crisis. In turn, the obesity crisis is thought to be responsible for the sharp rise in non-communicable diseases (diseases not caused by infection, such as type 2 diabetes).

It also highlights the ways in which guidelines and policies have been developed to address growing health concerns.

The review goes on to outline evidence about the potential impact of artificially sweetened drinks. It acknowledges that several systematic reviews of observational cohort studies and randomised controlled trials have found an association between artificially sweetened drinks and weight loss.

It also raises the point that there are long-standing concerns that replacing sugar sweetened drinks with artificially sweetened drinks may trigger various mechanisms in the body.

These may include increased appetite, increased preference for sweet taste, or simply overconsumption of solid foods due to awareness of the low calorie content from artificially sweetened drinks. However, these concerns were not backed up by any solid evidence.

The main points revolve around the potential negative health impact of artificially sweetened drinks. It also touches on the environmental impact of sweetened drinks, and goes on to discuss the implications for policy.

The researchers state that although national dietary guidelines generally recommend avoiding or reducing our intake of sugar sweetened drinks, the guidance surrounding consumption of artificially sweetened drinks is mixed. 

 

What did the researchers conclude?

The researchers conclude: "the absence of evidence to support the role of ASBs [artificially sweetened beverages] in preventing weight gain and the lack of studies on other long-term effects on health strengthen the position that ASBs should not be promoted as part of a healthy diet.

"In practice, this means that ASBs should not be recommended in dietary guidance and be subject to the same restrictions on advertising and promotion as those imposed on SSBs. New taxes implemented on SSBs should be applied at the same level to ASBs."

 

Conclusions

This review assessed a range of research exploring the the potential negative health impact of artificially sweetened drinks, compared to sugar sweetened drinks. The review is fairly one-sided, discussing the links between artificially sweetened drinks and the global obesity crisis, as well as the negative environmental impact of sweetened drinks.

The researchers suggest that national dietary guidance shouldn't recommend consuming artificially sweetened drinks as an alternative to sugar sweetened drinks.

However, a number of experts commenting on the review expressed the opinion that despite the lack of evidence for the benefits of artificially sweetened drinks, "diet drinks" were a better option than sugar sweetened drinks for people trying to lose weight.

Professor Naveed Sattar, Professor of Metabolic Medicine at the University of Glasgow commented, saying:

"I do not agree with the suggestion that diet drinks are no better than sugary drinks in terms of body weight. Whilst I agree the evidence base in terms of proper trials comparing sugary drinks with diet drinks are lacking for real end-points like weight or heart disease, intuitively a drink which contains lots of calories (i.e. sugary drinks) versus one that contains few or no calories (i.e. diet drinks) must be worse for health given clear adverse effects on dental health and clear gain of calories and so weight gain potential. To suggest otherwise would be irresponsible."

Prof Susan Jebb, Professor of Diet and Population Health at Oxford University said "artificially sweetened drinks are a step in the right direction to cut calories".

You could arguably draw a comparison between artificially sweetened drinks and e-cigarettes; neither may be ideal but they are both better than the alternative. 

Links To The Headlines

No evidence sugar-free soft drinks aid weight loss – study. The Guardian, January 3 2017

Diet drinks are not healthy and could trigger weight gain, say researchers. The Daily Telegraph, January 3 2017

Diet drinks 'make no difference to weight gain and shouldn't be seen as a healthier option', experts say. Daily Mail, January 3 2017

Sugar-free diet drinks do not aid weight loss and are no healthier than alternatives, research suggests. The Independent, January 3 2016

Links To Science

Borges MC, Louzada ML, de Sá TH, et al. Artificially Sweetened Beverages and the Response to the Global Obesity Crisis. PLOS Medicine. Published online January 3 2017

Grandparents who babysit 'tend to live longer'

"Grandparents who babysit their grandchildren tend to live longer than seniors who do not care for other people, a study has found," the Mail Online reports.

Researchers found grandparent babysitters had a 37% lower mortality risk than adults of the same age with no caring responsibilities.

The study included around 500 adults from the Berlin Aging Study (BASE) – a database of people aged 70 or older living in the former West Berlin.

It found that all participants involved in providing care or help to grandchildren had a reduced risk of dying during study follow-up than non-helpers. Similar positive effects were also found for participants who help support adult children and others in their social network.

But the study does have limitations, the main one being that it can't prove cause and effect.

Further research would be needed to find out what causes the increased life expectancy of caregivers. The researchers offer a number of explanations, such as spending time with grandchildren is a good way for older people to have a sense of purpose, while keeping them physically and mentally active.

Read more about how helping others may help improve your own wellbeing.

 

Where did the story come from?

The study was carried out by researchers from the University of Basel, University of Western Australia, and the Max Planck Institute for Human Development in Berlin. Funding was provided by the Max Planck Society, Free University of Berlin, German Federal Ministry for Research and Technology, German Federal Ministry for Family, Senior Citizens, Women, and Youth, and the Berlin-Brandenburg Academy of Sciences' Research Group on Aging and Societal development.

The study was published in the peer-reviewed medical journal Evolution and Human Behavior.

The study has been reported accurately in the Mail Online with a number of possible explanations given for the findings, as suggested by the research team. However, the website does not describe any of the research's limitations.
 

What kind of research was this?

This was a prospective cohort study which aimed to assess whether caregiving by grandparents within and beyond the family is associated with a longer life expectancy.

There is a growing body of research indicating that being a grandparent may be beneficial for a person's health, with possible positive effects on cognitive function and wellbeing.

However, other research has found possible negative effects on health, particularly when the grandparents have full-time custody of the children.

This research aimed to explore the effects of being a grandparent, looking at mortality specifically.

Attempts were made by the researchers to control for possible confounding factors. However, this can never be completely accurate as there may be a additional factors they haven't taken into account.

Also, as data was collected every two years by interview it may be subject to recall bias.

 

What did the research involve?

The researchers looked at data from the Berlin Aging Study (BASE). They aimed to investigate the effect of caregiving on mortality, using information on a range of health and social conditions obtained from the participants as well as information provided about their children and grandchildren.

The population in the BASE database was randomly selected from the West Berlin registration office records. Participants completed interviews and medical tests at their homes, doctors' practices and hospitals which were repeated at two yearly intervals between 1990 and 2009.

Participants were asked about their frequency of caregiving in the last 12 months. Caregiving was defined as looking after or doing something with a grandchild without the parents being present. This was then scored on a seven point scale, from 1 (never) to 7 (every day).

People who weren't grandparents were coded as "never". The sample did not include any primary caregivers who had full custody of the grandchildren.

The time to death following the interview was recorded and used as a measure for mortality.

Statistical analyses were performed to compare the life expectancy of caregiving grandparents, non-caregiving grandparents, and non-grandparents. The analysis was controlled for physical health, age, socioeconomic status and various characteristics of the children and grandchildren.

 

What were the basic results?

The 516 participants from the dataset were categorised as follows:

  • caregiving grandparents (80)
  • non-caregiving grandparents (232)
  • non-grandparents (204)

After adjustment for confounders, caregiving grandparents had a 37% lower risk of death than non-caregiving grandparents (hazard ratio [HR] 0.63, 95% confidence interval [CI] 0.41 to 0.96). An identical 37% risk reduction in mortality was found when comparing caregiving grandparents with non-grandparents.

There was no difference in risk of death between non-grandparents and non-caregiving grandparents (HR 0.90, 95% CI 0.78 to 1.15).

When looking at non-grandparents specifically, those who provided instrumental help to their adult children had 57% lower risk of death (HR 0.43, 95% CI 0.29 to 0.62) than parents who did not help their adult children.

For interviewed participants who were childless, those who reported giving support to others had 60% lower risk of death than those who did not report supporting others (HR 0.40, 95% CI 0.31 to 0.54).

 

How did the researchers interpret the results?

The researchers conclude: "All helper groups – grandparents who gave care to their grandchildren; parents who provided instrumental help to adult children; and childless participants who helped others in their social network – had higher survival probabilities than the respective non-helper group. This pattern suggests that there is a link not only between helping and beneficial health effects, but also between helping and mortality, and specifically between grandparental caregiving and mortality".

 

Conclusion

This prospective cohort study aimed to assess whether caregiving by grandparents within and beyond the family is associated with a longer life expectancy.

The researchers found that all participants involved in care of grandchildren, providing help to adult children and / or those helping others in their social network had a lower risk of dying during follow-up than non-helpers.

However, the study does have some limitations:

  • observational studies are not able to prove cause and effect. We can't say from these findings that the provision of care is directly responsible for a longer life
  • the researchers have attempted to adjust for a number of health and socio-demographic factors that could be influencing the results. But the number of variables that could be having an effect is potentially vast. Accounting for all contributing factors may have altered the findings
  • the cause of death and the participants' physical and mental health and wellbeing have not been explored in great depth
  • there is a risk of recall bias as data was collected during two yearly interviews and participants may not accurately remember the level of care provided
  • this is a relatively small sample of people – and they are also all from one region of Germany. Other results may be obtained with a different sample

This study provides some evidence for a link between caregiving and increased life expectancy, however it is not able to pinpoint what causes the increase. Further research would be required to confirm this.

However, spending time with grandchildren and helping friends and family members arguably gives people a sense of purpose, and helps keep them physically and mentally active.

There are all sorts of ways you can help others.

Read more about the different opportunities available for volunteering.

Links To The Headlines

Why it is SO important to babysit your grandchildren: Seniors who help out with childcare 'tend to live longer'. Mail Online, January 2 2017

Links To Science

Hilbrand S, Coall DA, Gerstorf D, Hertwig R. Caregiving within and beyond the family is associated with lower mortality for the caregiver: A prospective study. Evolution and Human Behavior. Published online December 5 2016

Our news predictions for 2017

Climate change continues to impact on public health

Despite what many commenters have said in 2016, climate change is real and is ongoing. That's the thing about science. Just because you don't believe in it, it doesn't go away.

In 2016 we have seen evidence of the impact of climate change in a number of different ways.

There was an anthrax outbreak in northern Russia as warm weather caused the release of previously frozen deadly anthrax spores.

And many experts think that the spread of the Zika virus across much of the Americas was made possible, in part, by changes in temperature that created environments in which the A. aegypti mosquito could survive.

It is hard to predict what further effects could occur in 2017. One possibility is that changes to the seasonal temperature in England could increase the length of the "pollen season", increasing the misery for allergy sufferers in this country. 

HIV vaccine is proven to work

There is a real possibility that a vaccine that prevents HIV from taking hold of a person’s immune system could be proven to be effective in 2017.

The vaccine – known as SAV001 – is designed to work by exposing the immune system to a safe, "deactivated" form of the virus. This then "teaches" the immune system to produce antibodies that can fight HIV.

Phase 2 trials – involving around 300 people – in order to see if the vaccine works as hoped are planned for 2017.

Virtual reality triggers real-world consequences

Many commenters predict that 2017 will become the year of virtual reality (VR). VR headsets and associated equipment are becoming cheaper while, at the same time, more powerful.

Like any technology, VR could lead to both health benefits and health risks.

For example, VR could be used to deliver "exposure therapy" to people with phobias. People with a fear of flying could experience the sensation of taking off in a plane without actually going to an airport. And if it gets all too much then there is always the "off switch".

VR could also be used in mindfulness training; placing users in a tranquil environment. 

We would also not be surprised if there were a number of reports on the negative impact of VR: people experiencing nausea; others getting carried away and tripping over wires; and possible claims that some heavy users have retreated from the real world entirely.

Crowdfunding research goes mainstream

Crowdfunding – where people are encouraged to provide financial support to projects they like – has flourished in recent years. Websites such as Kickstarter and Patreon have helped support a wide selection of projects, ranging from podcasts to multimillion pound video games.

There is now evidence that the same model is beginning to be applied to medical research. One website – Experiment.com – lists hundreds of projects that are seeking funding.

It may be a way to get support for what are known as orphan conditions – rare medical conditions that attract little funding from the larger research institutes.

Celebrity-based medicine continues to flourish

It seems in our celeb-obsessed media world, medical qualifications count for little. It's all down to whether you have ever been on the telly.

In 2016, former Page 3 girl Melinda Messenger was given over 1,500 words by the Daily Mail to argue that the cancer-preventing HPV vaccine was dangerous.

The Mail Online also included an interview with the daughter of Rolling Stones guitarist Ronnie Wood, who informed us that chemotherapy for cancer was bad for you and that apricot seeds were an effective treatment for breast cancer.

Hope you have a safe and happy New Year and see you in 2017.

 

Edited by NHS Choices. Follow NHS Choices on Twitter. Join the Healthy Evidence forum.

The 10 most popular stories from 2016 - as picked by you

10: Ibuprofen-like painkillers linked to an increased risk of heart failure 

"Ibuprofen could raise the risk of heart failure by up to 83%," the Daily Mirror warned in September.

But this was a misleading headline as the "83%" figure was related to an obscure type of painkiller called ketorolac and not ibuprofen, which should be a safe option for any festive headaches.

Find out more...

9: Exercise is 'most effective' method of preventing lower back pain

"Exercise is the best medicine to banish back pain and stop people taking sick days," the Daily Mirror reported at the beginning of the year; which turned out to be another misleading headline.

The study was looking at ways to prevent, not treat, lower back pain. Still, current guidelines recommend that people with back pain remain as active as possible.

Find out more...

8: Many women think shaving pubic hair is 'hygienic'

"More women think shaving pubic hair is 'hygenic' [sic] despite greater health risks," The Independent reported in July.

An online survey of more than 3,000 US women found that more than half of women who groomed their pubic hair did so for "hygiene reasons".

But as we pointed out at the time, like most things we have on the body, pubic hair does have a purpose, such as protecting against infection.

Find out more...

7: Grooming pubic hair linked to increased STI risk

"Women and men who regularly trim or remove all their pubic hair run a greater risk of sexually transmitted infections," BBC News reported earlier this month.

Still, the study the BBC reported on couldn't prove cause and effect. It could be that some groomers decided to take up the practice after getting an STI.

Find out more...

6: Warning over babies sleeping in car seats

"Long periods sleeping in car seats may be dangerous for young babies," the Daily Mail reported. The results of a small study suggested spending long periods of time in a car seat may lead to babies having breathing difficulties.

Researchers used a novel baby car seat simulator designed to reproduce the vibration a baby experiences when placed in a rear-facing car seat in a car travelling at 30mph.

Francine Bate, chief executive of the Lullaby Trust, the charity who funded the study, advised parents to keep a watchful eye on babies travelling in a car seat, and to also avoid driving long distances without taking a break.

Find out more...

5: Study says there's no link between cholesterol and heart disease

"Controversial report claims there's no link between 'bad cholesterol' and heart disease," the Daily Mail reported. A new review looking at previous studies on the role of so-called bad cholesterol in heart diseases was released in June.

Like any review its results are as only reliable as the studies being looked at.

It should also be noted that nine of the authors are members of THINCS – The International Network of Cholesterol Skeptics; so not exactly dispassionate observers.

Find out more...

4: Gut bacteria may be linked to 'dangerous' body fat

BBC News reported that: "The make-up of the bacteria found in human faeces may influence levels of dangerous fat in our bodies."

A study from September found a link between certain patterns of bacterial diversity – the different types of bacteria in the gut – and levels of visceral fat. Visceral fat is stored around the internal organs and is associated with a higher risk of metabolic diseases.

Exactly what we could do to alter gut bacteria patterns in our favour is currently unclear.

Find out more...

3: Talc and ovarian cancer: what the most recent evidence shows

"Talc 'is linked to ovarian cancer','' the Mail Online reported. That was the finding of a recent study looking at whether talcum powder can increase the risk of ovarian cancer – an association made newsworthy by a high-profile court case in the US.

Researchers studied more than 2,000 women with ovarian cancer and a similar-sized control group who were free of disease. Overall, they found a 33% increase in the risk of ovarian cancer with genital talc use. However the study was unable to prove a direct cause and effect relationship.

Find out more...

2: Link between indigestion drugs and dementia 'inconclusive'

"Indigestion pills taken by millions 'could raise the risk of dementia by 50%'," reported the Daily Mail. This headline is about a class of prescription drugs known as proton pump inhibitors (PPIs), such as omeprazole, used to treat heartburn.

While the headline sounded scary there was no cause for alarm. The study the Mail reported on compared two very different groups.

Those taking PPIs had poorer health, and were more likely to be taking a greater number of medicines and have conditions linked to a higher risk of dementia. A study where the characteristics of the two groups are more closely matched would be a useful next step.

Find out more...

1: Zika virus - your questions answered

The beginning of 2016 may seem like a long time ago now as so many things have happened. So it may be hard to remember that in January there was just one big health news story – the Zika virus.

First detected in Uganda in 1947, this mosquito-borne virus suddenly starting spreading through South America. 

It has now also spread to Central America, the Caribbean, South East Asia and some of the southern states of the US.

While the virus is not harmful in most cases it can trigger birth defects in the form of abnormally small heads (microcephaly).

There is currently no vaccine or treatment for the virus and pregnant women are advised against travelling to areas known to be affected.

Find out more...

Behind the Headlines 2016 Quiz of the Year

In 2016, Behind the Headlines covered more than 300 health stories that made it into the mainstream media. If you've been paying attention you should find this quiz easy and fun.

Answers are at the foot of the page (no peeking!).

 

In January 2016's health news...

In a controversial study, monkeys were genetically engineered to develop what condition?

  1. Sex addiction
  2. Bipolar disorder
  3. Autism

In a similarly controversial study, what psychological condition was dismissed as a "myth"?

  1. Seasonal affective disorder
  2. Agoraphobia
  3. Social anxiety disorder
In February 2016's health news...

Brain scans were used to see if what activity was addictive?

  1. Shopping online
  2. Checking your emails
  3. Using Facebook

Exercise in middle age was claimed to stop what from shrinking?

  1. Your brain
  2. Your penis (assuming you have one)
  3. Your height
In March 2016's health news...

What could possibly "break your heart" (or at least damage your heart muscles)?

  1. Moments of joy
  2. A sudden shock
  3. The loss of a much loved pet

Why should you always be polite to your doctor?

  1. Well-liked patients are often pushed to the front of the waiting list
  2. You are more likely to get an appointment when you want
  3. Rude patients are "more likely to be misdiagnosed"  
In April 2016's health news...

What was said to put off bedbugs from making a nest in your mattress?

  1. Making sure your bed sheets were either yellow or green
  2. Burning a scented candle every evening
  3. Regularly playing opera (or any other music that contains high-pitched noises)

What group leisure activity was found to boost immunity in people recovering from cancer?

  1. Line dancing
  2. Singing in a choir
  3. Amateur dramatics  
In May 2016's health news...

What psychoactive substance was tested as a treatment for depression?

  1. Peyote
  2. Psilocybin
  3. DMT

What was said to help babies sleep better?

  1. A massage
  2. A bath before bedtime
  3. Leaving them to cry  
In June 2016's health news...

Researchers claimed one of the following proverbs about food could actually be evidenced-based?

  1. All happiness depends on a leisurely breakfast
  2. Beer after wine and you'll feel fine; wine after beer and you'll feel queer
  3. Eat breakfast like a king, lunch like a prince and dinner like a pauper

What was said to be a bad influence on young girls?

  1. Disney Princess culture
  2. Selfies
  3. YouTube "vloggers"  
In July 2016's health news...

What could millions of people have without realising it?

  1. A parasite inside their digestive system
  2. A "secret ginger gene"
  3. An extra bone inside their foot

What increasingly popular activity was linked to blood clots?

  1. Zumba dancing
  2. Binge-watching box sets
  3. "Screen walking" – checking your phone screen while walking  
In August 2016's health news...

What popular types of summer venues were said to be becoming measles hotspots 

  1. Beaches
  2. Water parks
  3. Music festivals

A decline in the quality of what could have potential human implications?

  1. Bee pollen
  2. Dog sperm
  3. Ant eggs  
In September 2016's health news...

What skin condition could delay the signs of ageing?

  1. Acne
  2. Eczema
  3. Psoriasis

What activity could help you pass a kidney stone?

  1. Paragliding
  2. Riding a roller coaster 
  3. Snowboarding
In October 2016's health news...

What did we describe as "lukewarm at best"?

  1. Claims coffee prevented dementia
  2. Claims that hot baths prevented high blood pressure
  3. Claims that electric heating blankets prevented erectile dysfunction

What was reported as putting people off making appointments to see their GP?

  1. Receptionists asking questions about symptoms
  2. Sitting in a waiting room full of sick people
  3. Having to take time off work  
In November 2016's health news...

Adults who spent time doing what activity in childhood were reported as having better mental health?

  1. Going to regular religious services
  2. Eating a vegan diet
  3. Belonging to the Scouts or Girl Guides

Using what type of sporting equipment was said to help you live longer?

  1. Golf clubs
  2. Exercise bikes
  3. Racquets  
In December 2016's health news...

What type of exercise was said to be best for sperm quality?

  1. No exercise
  2. Moderate exercise
  3. Intense exercise

Regular pubic hair grooming was linked to what?

  1. Increased risk of sexually transmitted infections
  2. Triggering acne on the skin of the inner thighs 
  3. In men – shrinkage of the scrotum
Answers January

In a controversial study, monkeys were genetically engineered to develop what disorder?

In a similarly controversial study, what psychological condition was dismissed as a "myth"?

February 

Brain scans were used to see if what activity was addictive?

Exercise in middle age was claimed to stop what from shrinking?

March

What could possibly "break your heart" (or at least damage your heart muscles)?

Why should you always be polite to your doctor?

April

What was said to put off bedbugs from making a nest in your mattress?

What group leisure activity was found to boost immunity in people recovering from cancer?

May

What psychoactive substance was tested as a treatment for depression?

What was said to help babies sleep better?

June

Researchers claimed what following proverb about food could actually be evidenced-based?

What was said to be a bad influence on young girls?

July

What could millions of people have without realising it? 

What increasingly popular activity was linked to blood clots?

August

What popular types of summer venues were said to be becoming measles hotspots?

A decline in the quality of what could have potential human implications?

September

What skin condition could delay the signs of ageing?

What activity could help you pass a kidney stone?

October

What did we describe as "lukewarm at best"?

What was reported as putting people off making appointments to see their GP?

November

Adults who spent time doing what activity in childhood were reported as having better mental health?

Using what type of sporting equipment was said to help you live longer?

December

What type of exercise was said to be best for sperm quality?

Regular pubic hair grooming was linked to what?

Scores:
  • 0-2: Carry on Again Doctor (1969): Dr Nookey is disgraced and sent to a remote island hospital...
  • 3-5: Dr. Dolittle 2 (2001): Dolittle must save a forest and a bear's life...
  • 6-8: The Return of Doctor X (1939): A hotshot reporter and a young doctor team up to investigate a series of grisly murders and a mysterious sample of synthetic blood...
  • 9-11: The Fiendish Plot of Dr. Fu Manchu (1980): Fu Manchu's 168th birthday celebration is dampened when a hapless flunky spills Fu's age-regressing elixir vitae...
  • 12-15: The Island of Dr. Moreau (1977): A shipwrecked survivor discovers a remote island with a mad scientist...
  • 16-19: Doctor Strange (2016): A former neurosurgeon embarks on a journey of healing only to be drawn into the world of the mystic arts...
  • 20-23: Dr. Who and the Daleks (1965): An eccentric inventor and his companions travel in his TARDIS to the Planet Skaro and battle the evil menace of the Daleks...
  • 24: Doctor Zhivago (1965): The life of a Russian physician and poet who, although married to another, falls in love with a political activist's wife and experiences hardship...

Thanks for taking part and we hope you had fun and have a happy and healthy 2017. 

Edited by NHS Choices.
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Behind the Headlines on Twitter.

Want to feel happier? Take a break from Facebook

"Facebook lurking makes you miserable, says study," BBC News reports after a Danish study found regular users who took a week-long break from the social media site reported increased wellbeing.

The one-week trial assigned Facebook users to either give up using the site for a week, or go on using it usual.

They were then asked about their emotions and life satisfaction both before and after quitting Facebook.

Researchers also compared the effect of quitting between heavier and lighter Facebook users.

The study found heavy Facebook users experienced a greater increase in satisfaction with their life when not using it for a week, compared with less heavy users.

The author of the study suggests Facebook use may induce feelings of envy and dissatisfaction because users compare themselves with others when scrolling through posts and photos – a practice known as "lurking", described in one paper as "scrolling through endless photos of Sandra's new Gucci handbag".

This sounds reasonable, but in an unblinded study people were aware of what they were being asked to do. 

This means it's possible that their expectations of a benefit from not using Facebook might have translated into how they reported their satisfaction.

Facebook certainly isn't all bad: it allows you to connect with far-flung friends and family over the festive period. But it's no substitute for actual face-to-face interaction.

Read more about how connecting with others can improve wellbeing.

Where did the story come from?

The study was carried out by one researcher from the University of Copenhagen in Denmark. There were no external sources of funding.

It was published in the peer-reviewed journal Cyberphysiology, Behaviour and Social Networking, and is available on an open access basis, so it's free to read online.

UK media coverage around this study was generally balanced, albeit quite focused on the negative effects of using Facebook over Christmas – but this isn't what the study looked at. And the study was actually published at the beginning of November. 

Reports also focused on lurking on Facebook as opposed to using it to engage in conversation with others. While the practice of lurking was discussed in the study, there was no research into what effects it may have.

What kind of research was this?

This randomised controlled trial (RCT) aimed to investigate the effect of refraining from Facebook use on wellbeing.

The social networking site grows in popularity every day, reporting 1.59 billion active users in December 2015.

However, previous research has suggested Facebook use can have a negative effect on wellbeing. The study's author wanted to look into this association further.

RCTs are one of the best ways to determine the effects of an intervention – in this case, not using Facebook for a week.

What did the research involve?

The one-week study recruited 1,905 Danish people on Facebook. Of those included in the study, 86% were female, had an average age of 34 and an average of 350 Facebook friends. They spent a little over an hour on Facebook every day.

They were randomly assigned to one of the following groups:

  • do not use Facebook in the following week (treatment group)
  • keep using Facebook as usual in the following week (control group)

At both the start and end of the study, all participants were required to answer a 15-minute online questionnaire, which included topics such as:

  • intensity of Facebook use – this question covered six items, including number of Facebook friends and time spent on Facebook daily
  • Facebook envy – this required participants to report levels of envy towards statements covering things like "how much of the world others have seen/how successful others are/how happy others are"
  • active Facebook use – this was measured through questions about how often the participants posted a picture or updated their status
  • passive Facebook use – this related to how often participants browsed the newsfeed, viewed friends' photos, or browsed a friend's timeline

The participants were also asked about their wellbeing through:

  • life satisfaction – determined through a question in the questionnaire that asked, "In general, how satisfied are you with your life today?"
  • emotions – measured through nine items using questions from the Center for Epidemiologic Studies Depression (CES-D) Scale and the Positive Affect Negative Affect Scale (PANAS), both well-validated methods of assessing emotions and mood; participants were asked about levels of enthusiasm, happiness, loneliness, enjoyment of life, depressiveness, sadness, decisiveness, anger and worry

Of the 1,097 participants, 81% completed the one-week trial. The data obtained through the questionnaires was used to test five hypotheses:

  1. Facebook use affects life satisfaction negatively.
  2. Facebook use affects emotions negatively.
  3. The effect of quitting Facebook on wellbeing is greater for heavy Facebook users than for light Facebook users.
  4. The effect of quitting Facebook on wellbeing is greater for Facebook users who feel Facebook envy than for users not feeling Facebook envy.
  5. The effect of quitting Facebook on wellbeing is greater for people using Facebook passively compared with people using Facebook actively.
What were the basic results?

Overall, the study found people experienced greater levels of satisfaction with their life when not using Facebook for one week, compared with Facebook users.

The treatment group reported significantly higher levels of life satisfaction (range: 1-10) of 8.11 compared with 7.74 in the control group.

The same effect was seen on the emotion items (range: 9-45), with the treatment group reporting an average of 36.21 compared with 33.99 in the control group.

Intensity of Facebook usage was split into three groups: light, medium and high. Light Facebook users experienced no effect through quitting Facebook (0.77 in the treatment group compared with 0.75 in the control group), whereas heavy users felt the greatest effect (0.77 in the treatment group compared with 0.69 in the control group).

Additionally, the effect of quitting Facebook was greatest for users who felt the highest levels of Facebook envy, as reported in the questionnaires.

How did the researchers interpret the results?

The researcher concluded that, "First, the present study provides causal evidence that quitting Facebook leads to higher levels of both cognitive and affective wellbeing.

"The participants who took a one-week break from Facebook reported significantly higher levels of life satisfaction and a significantly improved emotional life."

He added: "Second, the study showed that the (causal) gain of wellbeing varied in relation to how people use Facebook.

"The gain proved to be greatest for heavy Facebook users, users who passively use Facebook, and users who tend to envy others on Facebook.

"These findings indicate that it might not be necessary to quit Facebook for good to increase one's wellbeing – instead an adjustment of one's behaviour on Facebook could potentially cause a change." 

Conclusion

This randomised controlled trial (RCT) aimed to investigate the effect of refraining from Facebook use on wellbeing.

It found people experienced greater levels of satisfaction with their life when not using Facebook for a week, compared with Facebook users.

This is a very interesting study and very relevant due to the large number of people across the world who use Facebook.

However, there are a few points to note:

  • This study was limited to a one-week period, and the effects of quitting Facebook may be different in the long term. Further research is needed to look into the long-term effects.
  • The participants were mainly women, so it may not be possible to apply these findings to the general population.
  • This study was not able to enforce quitting Facebook use in the treatment group, so it's possible some people "cheated" and carried on using Facebook.
  • As an unblinded study without a placebo group, it is possible that people's prior expectations of a benefit from a break from Facebook led to positive reporting on satisfaction scores later.
  • It isn't possible to confirm that the feelings reported in the questionnaires are a direct result of Facebook use, rather than the effect of something else in the participants' lives.

Facebook certainly isn't all bad: it allows you to connect with far-flung friends and family over the festive period. But it's no substitute for actual face-to-face interaction.

Read more about how connecting with others can improve wellbeing.

Links To The Headlines

Facebook lurking makes you miserable, says study. BBC News, December 22 2016

Facebook break can boost wellbeing, study suggests. The Guardian, December 22 2016

How "lurking" on Facebook will ruin your Christmas. Daily Mirror, December 22 2016

Facebook stalking friends' 'perfect' Christmas snaps makes you miserable, study finds. The Sun, December 22 2016

Links To Science

Tromholt M. The Facebook Experiment: Quitting Facebook Leads to Higher Levels of Well-Being. Cyberpsychology, Behavior, and Social Networking. Published online November 1 2016

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